[COMBINED RESECTION OF THE CHEST WALL AND DIAPHRAGM IN PATIENTS WITH LUNG CANCER]

Surgical resection remains the only reliable curative method for lung cancer, and combined resection of the primary tumor and involved neighboring structures is performed when possible in patients with locally advanced disease. Lung cancers involving the chest wall and diaphragm are now classified as T3 lesions, and the surgical treatment for those tumors is generally accepted. However, the outcomes are frequently unsatisfactory, and the 5-year survival rates of patients with chest wall and diaphragmatic invasion were reported to be 30-40％ and 20-40％, respectively, with mortality rates of 1.8-7.8％ for chest wall resection and 0-2.0％ for diaphragm resection. In combined resection, a good surgical indication is N0-1 disease, and complete resection is essential. The indication for reconstruction of the chest wall is a large lesion in the caudal area which is not covered by the scapula. If the lesion area in the diaphragmatic muscle is smaller than fist size, it is possible to perform direct suturing with nonabsorbable bladed sutures. In cases of large lesions, diaphragmatic reconstruction using nonabsorbable material is necessary to prevent the herniation of abdominal organs. In the near future, it is hoped that multidisciplinary treatments including surgery will improve the outcomes of patients with those locally advanced lung cancer.