Non-small cell lung cancer with chest wall invasion: evolution of surgical treatment and prognosis in the last 3 decades.
OBJECTIVE
The treatment of patients with non-small cell lung cancer (NSCLC) that is invading the chest wall is still debated. We aim to illustrate the improvements in treatment results that have occurred over last decade.


METHODS
Retrospective analysis of our experience and an overview of the literature.


METHODS
Department of Surgery, San Giuseppe Hospital, University of Milan.


METHODS
From January 1970 to December 1999, of 2,738 patients with NSCLC, we operated on 146 patients (5.4%) with chest wall invasion by NSCLC. Superior sulcus tumors and tumors invading the diaphragm or mediastinum were excluded. We reclassified all cases according to the current TNM classification.


RESULTS
We registered one postoperative death (0.69%) and five major complications (3.4%). From 1970 to 1979, of 32 patients, 10 underwent an exploratory thoracotomy (ET) and 22 underwent a radical resection (stage IIB disease, 17 patients; stage IIIA disease, 5 patients). The 5-year survival rate was 22.7% (25% for stage IIB disease). From 1980 to 1989, of 67 patients, 11 underwent an ET and 56 underwent a radical resection (stage IIB disease, 34 patients; stage IIIA disease, 12 patients; stage IIIB disease, 5 patients; and stage IV disease, 5 patients). The survival rate following radical resection was 14.1%, ranging between 23.5% for patients with stage IIB disease and 0% (3 years, 14%) for those with stage IIIA disease. From 1990 to 1999, of 47 patients, 2 underwent an ET, 2 underwent an exploratory thoracoscopy, and 43 underwent a radical resection (stage IIB disease, 23 patients; stage IIIA disease, 20 patients). The survival rate was 42.7% (stage IIB disease, 78.5%; stage IIIA disease, 7.2%).


CONCLUSIONS
Considering the low morbidity, mortality, and significant improvement in survival during the last decade, we advocate the performance of radical en bloc resection for the treatment of chest wall invasive NSCLC.
Roviaro
Giancarlo
G
Department of General Surgery, University of Milan, San Giuseppe Hospital FbF-A. Fa. R., Italy. gian.roviaro@unimi.it
Varoli
Federico
F
Grignani
Fabrizio
F
Vergani
Contardo
C
Pagano
Claudio
C
Maciocco
Marco
M
Romanelli
Alberto
A
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D011013:Pneumonectomy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D035441:Thoracic Wall / Q000473:pathology* / Q000601:surgery; D013906:Thoracoscopy; D013908:Thoracotomy