[Invasion of the chest wall in primary lung neoplasms]

The authors analyse a series of 5 patients who underwent pulmonary and parietal resection between 1990 and 1993 due to non.microcytoma bronchogenic carcinoma with invasion of the thoracic wall. The patients comprised four men and one woman aged between 45 and 69 years old. Thoracic pain was present in two patients. Pulmonary resection with extrapleural stripping was performed in two patients whereas a block resection from one to five ribs and the corresponding intercostal spaces was performed in the other three patients. The authors' approach is not to perform these operations according to rigid protocols but to adapt them according to the local status of tumour invasion. Therefore to resort to extrapleural resection when there is a free cleavage plane between parietal pleura and rib wall; resection in block of the wall where the carcinoma has infiltrated the endothoracic fascia or deeper. The authors do not report any major complications and record a postoperative mortality rate of 0%. In two cases the thoracic wall was reconstructed using a sheet of Gore-Tex which did not provoke rejection phenomena. Radiotherapy was carried out in cases with positive lymph nodes. The series presented here is too recent to provide significant data regarding survival. However, the only factor seen to influence prognosis in the five patients was the presence or otherwise of lymph node metastasis, irrespective of the histological type and operation performed. The five year survival rate of T3N0M0 patients is in fact similar to that of T2N0M0 patients.(ABSTRACT TRUNCATED AT 250 WORDS)