En bloc resection for T3 bronchogenic carcinoma with chest wall invasion

From January 1960 to January 1986, 77 patients with lung cancer invading the chest wall underwent operations in the Department of Thoracic Surgery at the University of Rome. Chest pain, alone or with other symptoms, was the presenting complaint in 52 patients (67%). All patients underwent thoracotomy (25 pneumonectomy, 5 bilobectomy, 23 lobectomy, 2 wedge resection, 22 no pulmonary resection), with an operative mortality of 7.8%. At thoracotomy, mediastinal lymph node dissection was performed in 36 cases; after the operation 10 patients were classified as T3 N0 M0, 11 as T3 N1 M0, 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 on 37 patients. The actuarial 5-year survival of 55 patients following potentially curative resection was 15%. Five-year survival was 22% for N0, 12% for N1 and 8% for N2 patients. Five-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 was achieved in 45% of our patients. Resection of pulmonary parenchyma and part of the thoracic wall for lung cancer yields palliation of pain in a fairly large number of patients and may result in long-term survival in selected cases.