Surgical treatment of lung cancer invading chest wall: a retrospective analysis of 110 patients

Objective: To retrospectively assess the results of surgical treatment in a consecutive series of 110 patients with Stage IIb and IIIa non small cell lung cancer (NSCLC) invading chest wall. Methods: A series of 110 patients underwent surgery for Stage IIb and IIIa NSCLC with involvement of chest wall. There were 101 male and 9 female patients, mean age was 61.4 (range 32-74), 52 (47.3%) of them complaining for chest pain. Surgical procedures were pneumonectomy in seven patients (6.4%), lobectomy in 73 (66.4%), bi-lobectomy in six (5.4%) and wedge resection in 24 (21.8%). In 63 patients (57.3%) an extrapleural resection was performed while in the other 47 (42.7%) an 'en bloc' resection of tumor with chest wall was required. In 22 patients (76.3%) repair was achieved by muscle flap while in 8 (26.7%) a prosthesis was required. Five-year survival was computed using the Kaplan-Meier method; P values correspond to the log-rank test. Results. There were neither intraoperative nor postoperative deaths. Postoperative staging revealed 83 T3N0M0, 17 T3N1M0 and 10 T3N2M0. Mean postoperative hospital stay was 17.7 days (range, 5-40). For N0 patients 5 year survival was 47% (39/83) and no significant difference was noted when extrapleural and 'en bloc' resection groups were compared (P = 0.08). In N1/N2 patients no survival was observed (0/27) and comparison between surgical procedures was not statistically significant (P = 0.41). Moreover when NO patients were compared with NI patients the difference in survival was significant for both extrapleural (P = 0.02) and 'en bloc' (P = 0.04) groups. No difference was noted when the two surgical procedures, were compared independently form N status (P = 0.94). Within the group of patients undergone 'en bloc' resection survival was significantly better for NO patients as in the group of extrapleural resection. Conclusion: Surgical treatment of Stage IIb and IIIa NSCLC invading chest wall by extrapleural or 'en bloc' resection is widely adopted and justified by the good results in terms of morbidity and relief of pain. Survival is always depending on the N status. (C) 2001 Elsevier Science B.V. All rights. reserved.