[Bronchial cancers invading the chest wall]

One hundred and twenty five patients, considered as having a bronchial carcinoma invading the chest wall, suffered from a thoracic pain in 40 cases. They were operated on by pneumonectomy (23), bilobectomy (5), lobectomy (83) and atypical resection (1). Resection was impossible in 13 cases (10.4%), for anatomical (10) or functional reasons (3). Considering the chest wall, an extra-pleural resection was performed in 49 cases, a muscular resection in 25 cases and a skeletal resection in 38 cases. Parietal invasion was microscopically confirmed for 78 tumours out of 112 resections specimens and for 10 tumours out of 13 which were not resected: 65 T3 N0, 8 T3 N1, 15 T3 N2. Operative mortality was 12.5%. Global survival was 62.8% at 1 year, 14.2% at 3 years, 11.1% at 5 years. Median survivals were 393 days after resections dating back to more than 5 years and 158 days when the tumours were not resected. Thoracic pain is a symptom of chest wall invasion in 87.5% of cases, but the invasion is symptomless in 24% of cases. Sensitiveness, specificity and predicting values of imaging modalities are discussed: on the whole the negative predictive values are feeble (0.23 to 0.42). The operative estimation is also uncertain, especially considering invasion limited to the extra-pleural space. Practically, a fixed tumour with broad and firm adhesion to the chest wall is an indication for chest wall resection which gives better results, although this advantage is not statistically significant. Surgical prognosis of T3 cancers is, in this series, much worse than the prognosis of T2 tumours. Mortality is analyzed according to its causes.(ABSTRACT TRUNCATED AT 250 WORDS)