[Justifications and benefits of exploratory thoracotomy in stage IIIb bronchopulmonary cancer]

From January 1980 to December 1984, 270 patients underwent exploratory surgery for Non Small Cell Lung Cancer with or without peritumoral lymph node involvement. In group 1: for 167 patients (62%) unresectable cancer was found. In group 2: for 103 patients (38%) an extensive resection was feasible. This study allows comparison of these two groups and confirms the value of exploratory thoracotomy. The resection was extended to the superior vena cava in 12% of cases, the trachea and carina in 28.15% and the left atrium in 49.50%. Survival in group 1 was similar to that of non operated patients (i.e. less than 10% at one year) and the mortality was 1.2% with no operative mortality. Survival of group 2 was considerably better: 58% at 1 year, 26% at 3 years, 23% at 5 years. The mortality was 3.9% with no operative mortality. Three year survival of patients with T4 N0 was clearly higher than that of T4 N2 (38% versus 17%). Although the results were poor for patients with N3 disease and those who underwent incomplete resections, they were nonetheless better than in those patients with unresectable tumors (16% versus 9% at 18 months). We conclude that: exploratory thoracotomy is safe, a significant number of patients (38% in our series) may benefit from this approach, and that it is sometimes hazardous to contra-indicate surgery for patients suffering from lung cancer only on the basis of X-Ray findings.