Resection for peripheral higher stage lung tumor. A compared Italian cumulative experience

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Advanced non-small cell lung cancer (NSCLC) poses significant treatment challenges.
• Surgical approaches for higher-stage NSCLC vary, necessitating analysis of clinical outcomes.
• International benchmarks provide a reference for evaluating localized surgical experiences.

Purpose of the Study:

• To analyze the cumulative surgical experience with Stage III NSCLC from ten Italian centers.
• To compare the outcomes of different surgical techniques for peripheral NSCLC.
• To evaluate the 5-year survival rates in relation to surgical methods and staging.

Main Methods:

• Retrospective review of clinical records for 470 surgically treated Stage III NSCLC patients.
• Categorization of tumors into Pancoast, apical non-Pancoast, and lower thoracic cage tumors.
• Analysis of surgical procedures (en-bloc chest-wall resection vs. extrapleural dissection) and survival data.

Main Results:

• Overall 5-year survival for Pancoast tumors was 14%, with en-bloc resection yielding 20% survival versus 9% for extrapleural dissection.
• For other peripheral tumors, 5-year survival was 18%, with extrapleural dissection achieving 24.5% survival versus 15.6% for en-bloc resection.
• Italian survival rates were generally lower than international comparisons, particularly for Pancoast tumors.

Conclusions:

• Surgical approaches and outcomes for Stage III NSCLC in Italian centers show discordance with international references.
• Extrapleural dissection demonstrated better survival rates in certain peripheral NSCLC cases compared to en-bloc resection.
• Further investigation is needed to reconcile observed survival disparities and optimize surgical strategies for advanced NSCLC.