Surgical treatment of superior sulcus tumors: results and prognostic factors.
OBJECTIVE
To study the clinical characteristics, treatment modalities, and outcome of patients with superior sulcus tumors who underwent surgery over a 15-year period.


METHODS
Retrospective clinical study.


METHODS
Clinical records of all patients operated on for superior sulcus tumors by the same surgical team between 1988 and 2002 were reviewed retrospectively.


RESULTS
Sixty-seven patients were operated on in this period. All the patients underwent en bloc lung and chest wall resection. Surgical approaches were as follows: posterolateral thoracotomy according to Paulson (n = 33), combined transcervical and transthoracic approach (n = 33), and isolated transcervical approach (n = 1). Types of pulmonary resection included lobectomies (n = 59), pneumonectomies (n = 2), and wedge resections (n = 6). Pathologic stages were IIB, IIIA, and IIIB in 49 cases, 12 cases, and 6 cases, respectively. Resection was complete in 55 patients (82%). Operative mortality was 8.9% (n = 6). Postoperative treatment was administered in 53 patients (radiotherapy, n = 42; chemoradiotherapy, n = 9; and chemotherapy, n = 2). Overall 2-year and 5-year survival rates were 54.2% and 36.2%, respectively. Five-year survival was significantly higher after complete resection than after incomplete resection (44.9% vs 0%, p = 0.000065). The presence of associated major illness negatively affected the outcome (5-year survival, 16.9% vs 52%; p = 0.043). Age, weight loss, respiratory impairment, tumor size, presence of nodal disease, and histologic type did not influence the long-term outcome. At multivariate analysis, only the completeness of resection and the absence of associated major comorbidities had an independent positive prognostic value.


CONCLUSIONS
Superior sulcus tumor remains an extremely severe condition, but long-term survivals may be achieved in a large percentage of cases. The presence of associated major illness and the completeness of resection are the two most important factors affecting the long-term outcome.
Alifano
Marco
M
Unité de Chirurgie Thoracique, Hôtel-Dieu, AP-HP, 1 Place du Parvis Nôtre-Dame, 75004 Paris, France.
D'Aiuto
Massimiliano
M
Magdeleinat
Pierre
P
Poupardin
Eric
E
Chafik
Aziz
A
Strano
Salvatore
S
Regnard
Jean François
JF
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010178:Pancoast Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011013:Pneumonectomy; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013908:Thoracotomy; D016896:Treatment Outcome