Extended intrathoracic resection for lung cancer. Follow-up of 49 cases

Extended resection was performed for primary lung cancer (stage III) on 49 patients in 1973-1982. Their mean age was 61 (38-76) years. In addition to pneumonectomy (29) or lobectomy (20), surgery included resection of the thoracic wall (8 cases) left atrium (12), pericardium (15), parietal pleura (13) and oesophagus (1 case). Among the 47 "surgical survivors" (96%), the mean survival time was 19.9 +/- SD 20.3 months, and only four patients (9%) were alive after 5 years or more. The cumulative 5-year survival was 14% (4/29 patients). Poorly differentiated tumour forms (squamous cell cancer) carried the worst prognosis, whereas the type of resection and presence or absence of lymph-node metastases did not per se influence survival. The prognosis in extended resection is poorer than in standard lung resection, but superior to that in simple exploration. The surgeon therefore should always be prepared to extend a planned resection when a patient on the operating table is found to have extension of lung cancer to other intrathoracic organs, since only in invasion of the chest wall is the surgical strategy as a rule clear from the outset.