Results of surgical treatment of stage III lung cancer

The role of surgery in the management of Stage III lung cancer is controversial. A retrospective analysis of our experience with 220 Stage III patients treated surgically (Stage IIIa n = 174, Stage IIIb n = 46) form the basis of this report. Of the 140 patients who underwent resection only 88 were considered to be potentially curative, all but two being operated in Stage IIIa. The overall 5-year survival rate for Stage III lung cancer was 12.1% whilst curative resection had a 5-year survival rate of 31.8%. The 5-year survival rate increased to 42% with curative resection for T3N0M0 patients. There were no 5-year survivors with incomplete resection. There were no 5-year survivors in Stage IIIb disease. Five-year survival rates for N0 (n = 62), N1 (n = 78), and N2 (n = 80) irrespective of T status were 37.2%, 3.4% and 5.6%, respectively. The operative mortality rate was only 3.4% for curative resection while palliative or non-resection patients had a mortality rate of 10.6%. Eighty-eight patients, 55 of Stage IIIa and 23 of Stage IIIb had postoperative radiotherapy with a median survival of 12 and 9 months, respectively. Fifteen small cell carcinoma patients had postoperative adjuvant chemotherapy with a median survival of 6.5 months. The only 5-year survivor in this group also had a curative resection. We conclude that metastasis to lymph nodes usually implies systemic disease and a poor prognosis. Surgical therapy continues to be the treatment of choice in a small subset of patients with Stage III resectable lung cancer discovered at thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)