Surgery of bronchogenic carcinoma invading the chest wall

A series of 77 patients affected by lung cancer invading the chest wall who underwent surgery is reported. They were selected from 5236 lung cancer patients observed over a 25-year period. Chest pain was the presenting complaint, alone or with other symptoms, in 52 patient (76%). All patients underwent thoracotomy (pneumonectomy 25 cases, bilobectomy 5, lobectomy 23, wedge resection 2, no pulmonary resection 22), with an operative mortality of 7.8%. At thoracotomy, mediastinal lymph node dissection was performed in 36 cases; after surgery, 10 patients were classified as T3 NO MO, 11 as T3 N1 N0, 15 as T3 N2 M0; 19 patients (34.5%) were staged T3 Nx M0 because mediastinal dissection was not performed. "En bloc" resection of the chest wall was performed in 37 patients. The actuarial 5-year survival of 55 patients receiving potentially curative resection was 14%. 5-year survival was 22% for N0, 12% for N1 and 8% for N2 patients. 5-year survival for squamous-cell, large-cell and adenocarcinoma was 22%, 10% and 14% respectively. T3 N0 M0 patients with squamous-cell carcinoma had a 5-year survival of 32%. Pain relief has been obtained in 45% of patients. Resection of pulmonary parenchyma and attached chest wall for lung cancer, yields palliation of pain in a fairly large number of patients and can result in long-term survival in selected cases.