Prognostic factors after surgical treatment of lung cancer invading the diaphragm.
BACKGROUND
Diaphragmatic invasion from lung cancer (T3-diaphragm) is a rare occurrence reported to portend a poor prognosis.


METHODS
Fifteen patients with T3-diaphragm (14 males, 1 female; median age, 64 years) were surgically treated over a twenty-year period by en bloc resection (14 patients). One patient was only explored. Pathologic stage IIB (T3N0) was found in 11 patients. A partial infiltration of the diaphragm was observed in 3 patients, whereas full-depth invasion was found in 12. Diaphragmatic reconstruction was done primarily in 9 patients, and, by prosthetic material in 5.


RESULTS
Two patients are still alive without evidence of disease at 88, and, 114 months from surgery. Overall median survival was 23 months (range, 3 to 168). The actuarial 5-year survival was 20%, when all patients were considered, and, 27%, for T3N0 patients. Univariate analysis showed that prosthetic replacement of the muscle (p = 0.018) was significantly related to survival.


CONCLUSIONS
T3-diaphragm is best treated with en bloc resections with wide tumor-free margins and prosthetic replacement of the diaphragm.
Rocco
G
G
Division of General Thoracic Surgery, Azienda Ospedaliera E. Morelli, Sondalo, (Sondrio), Italy. grocco@novanet.it
Rendina
E A
EA
Meroni
A
A
Venuta
F
F
Della Pona
C
C
De Giacomo
T
T
Robustellini
M
M
Rossi
G
G
Massera
F
F
Vertemati
G
G
Rizzi
A
A
Coloni
G F
GF
D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D013526:Surgical Mesh; D015996:Survival Rate