Extended operation for T4 lung carcinoma

The extended surgery for T4 lung carcinoma was reviewed. From literature in the last decade, the 5-year survival rate has been under 10% worldwide. However a more favorable prognosis will be expected nowadays because of the progress of perioperative intensive care and appearance of effective anticancerous agents for induction chemotherapy. We compared the results of surgery for T4 lung carcinoma from 1978 to 1989, to those from 1992 to 1997. The 3 and 5-year survivals in the former period were 6.8% respectively, however in the latter period the 3-year survival rate rose to 24.6%. In patients with T4, the prognoses are different according to the involved organs by lung carcinoma. Generally, combined resection of the trachea, carina, descending aorta and left atrium show better prognoses compared to that of the esophagus and liver. We consider that malignant pleural effusion with N2 should not be the object for panpleuropneumonectomy. In our series from 1992 to 1997 median survival time (MST) of T4 with N0 or N1 was 25.5 months, on the other hand MST with N2 or N3 was 14.2 months. Histologically patients with squamous cell carcinoma showed a better prognosis than those with adenocarcinoma. From these results, in the extended operation for T4 we may expect more favorable prognoses in cases with involvements of the trachea, carina, aorta and left atrium, and with N0 or N1, histologically squamous cell carcinoma.