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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 836-841, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BC McCaughan, N Martini, MS Bains and PM McCormack
From 1974 through 1983, 125 patients underwent operation at Memorial
Sloan-Kettering Cancer Center for non-small cell carcinoma of the lung
invading the chest wall. (Excluded are those with superior sulcus tumors or
distant metastases at presentation.) Eighty patients were male and 45 were
female. Ages ranged from 33 to 88 years (median 60 years). Histologically,
the tumors were epidermoid carcinoma in 46%, adenocarcinoma in 46%, and
large cell carcinoma in 8%. All patients underwent thoracotomy
(pneumonectomy 19, bilobectomy seven, lobectomy 75, wedge resection 10, and
no pulmonary resection 14), with an operative mortality of 4%. At
thoracotomy, mediastinal lymph node dissection was routinely performed, and
the postsurgical stage was T3 N0 M0 in 53%, T3 N1 M0 in 13%, and T3 N2 M0
in 34%. Extrapleural resection was performed in 66 patients. En bloc
resection of chest wall and lung was performed in 45 patients with an
operative mortality of 2%. Complete resection of tumor was possible in 77
patients (62%). Extension of tumor beyond the parietal pleura significantly
decreased resectability. The median survival of 48 patients having
incomplete resection was 9 months, despite perioperative interstitial and
external radiation. The actuarial 5 year survival rate (Kaplan-Meier) of 77
patients having complete resection was 40%. This percentage was not
significantly influenced by the patient's age or sex or by tumor size or
histologic type. Lymphatic metastases significantly reduced survival, with
a 5 year actuarial survival rate of 56% for patients with T3 N0 M0 disease
and 21% for those with T3 N1 M0 or T3 N2 M0 disease (p = 0.005). The extent
of tumor invasion of the chest wall appeared to influence survival, but in
the absence of lymphatic metastases the difference at 5 years was not
significant. Complete resection offers a significant chance for long-term
survival in lung cancer directly extending into parietal pleura and chest
wall. Extrapleural resection or en bloc chest wall resection can be
performed with a low operative mortality and an expected 5 year survival in
excess of 50% in the absence of lymphatic metastases.
ARTICLES
Chest wall invasion in carcinoma of the lung. Therapeutic and prognostic implications
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