Surgical approach to non-small cell lung cancer involving the chest wall

Treatment of NSCLC invading the chest wall (T3) remains controversial. Surgery is undoubtedly the only chance for these neoplasms, but its role regarding the T3N2 tumors is highly questionable. Between 1975 and 1994, 710 NSCLC patients underwent surgery in our department. Of these, 38 with tumor involvement of the chest wall underwent curative resection: en bloc resection or extrapleural resection, and 31 of these patients (19 with T3N0 tumors and 12 with T3N1-N2 tumors) were available for estimating long-term survival. The overall survival was 20.5% at 5 years and 15.4% at 10 years. Patients without lymph-node involvement had a survival rate of 26.2% at 5 years and 19.27% at 10 years. No patient with T3N2 tumor was alive 5 years after surgery. Patients with T3N1 tumor had a survival rate of 16.7% at both 5 and 10 years. The difference between T3N0 and T3N2 tumors was statistically significant. Neither histologic type nor depth of chest wall involvement had a significant impact on survival. En bloc or extrapleural resection, if curative, can be effective in T3N0-N1 tumors. Surgery is inadequate for the treatment of T3N2 tumors with chest wall involvement.