[Primary pulmonary carcinoma and Pancoast syndrome]

Although the treatment of Pancoast tumours usually combines radiotherapy and surgery, poor prognosis has been reported. The influence of clinical signs and extension of surgical resection on long-term survival has not yet been systematically investigated.

Between 1977 and 1997, among 1129 patients operated consecutively in our institution for a bronchogenic carcinoma, 14 (1.2%) presented a Pancoast tumour. Delay between the onset of symptoms and definite diagnosis ranged from 1 to 14 months (median 7 months). A complete surgical resection was performed in 7 patients, 6 of whom did not have mediastinal lymph node metastasis. Radiotherapy or radiochemotherapy was performed in all patients.

Overall 5-year survival rate is 36%. However, 5-year survival rate increases up to 60% if the diagnosis is established within 6 months after the onset of symptoms, and up to 67% if the tumour has been removed without mediastinal lymph node metastasis. In contrast, the 5-year survival rate decreases to 20% or 0% respectively, if symptoms last more than 6 months, or if tumoral resection is incomplete.

The incidence of Pancoast tumours compared to other bronchogenic carcinomas is low. An early diagnosis allows complete resection of the tumour and contributes to improve survival.