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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 8-12, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
M Albertucci, TR DeMeester, M Rothberg, JA Hagen, R Santoscoy and TC Smyrk
Among 37 patients with peripheral T3 lung lesions, preoperative clinical
and imaging evidence was suggestive of T3 disease in 28 and of T2 disease
in nine. Intraoperatively, the T2 designation was changed to T3 on the
basis of adherence of the tumor to the parietal pleura. All had
mediastinoscopy followed by resection and complete lymph node dissection.
There were 17 lobectomies and 20 pneumonectomies. The chest wall was
resected in continuity with the lung in 21 patients, and in 16 only an
extrapleural resection was done. Follow-up was completed in all patients
(range 2 to 14 years, median 7 years). The 5-year actuarial survival rate
for all patients was 30%. As expected, the presence of lymph node
metastasis affected the 5-year actuarial survival rate: N0 = 41%; N1 = 29%,
and N2 = 0%. Histologic examination of the resected specimen confirmed a T3
lesion in 30 patients. The tumor was removed completely in 100% of patients
whose chest wall was resected in continuity with the lung but in only 31%
in whom an extrapleural resection was done. In the absence of lymph node
metastasis, the 5-year survival rate of patients after en bloc resection of
the chest wall was 50% compared with 33% for those with extrapleural
resection (p less than 0.05). The finding of a peripheral lung tumor
adherent to the parietal pleura indicates, in most instances, extension
through the parietal pleura. When tumor is firmly adherent to the parietal
pleura, an en bloc resection of the chest wall rather than an extrapleural
dissection should be performed. This assures complete tumor removal and
improves the probability of long-term survival.
ARTICLES
Surgery and the management of peripheral lung tumors adherent to the parietal pleura
Department of Surgery, Creighton University School of Medicine, Omaha, Neb.
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