title: Results of surgical treatment of T4 non-small cell lung cancer.
abstract: OBJECTIVE
  Because of location and invasion of surrounding structures, the role of surgical treatment for T4 tumors remains unclear. Extended resections carry a high mortality and should be restricted for selected patients. This study clarifies the selection process in non-small cell T4 tumors with invasion of the mediastinum, recurrent nerve, heart, great vessels, trachea, esophagus, vertebral body, and carina, or with malignant pleural effusion.
  
  
  METHODS
  From 1977 through 1993, 89 patients underwent resection for primary non-small cell T4 carcinomas. Resection was regarded as complete in 34 patients (38.2%) and incomplete in 55 patients (61.8%). Actuarial survival time was calculated and risk factors for late death were identified.
  
  
  RESULTS
  Overall hospital mortality was 19.1% (n=17). Mean 5-year survival was 23.6% for all hospital survivors, 46.2% for patients with complete resection and 10.9% for patients with incomplete resection (P=0.0009). In patients with complete resection, mean 5-year survival for patients with invasion of great vessels was 35.7%, whereas mean 5-year survival for invasion of other structures was 58.3% (P=0.05). Age, mediastinal lymph node involvement, type of operative procedure, and postoperative radiotherapy did not significantly influence survival.
  
  
  CONCLUSIONS
  In certain T4 tumors complete resection is possible, resulting in good mean 5-year survival especially for tumors with invasion of the trachea or carina. High hospital mortality makes careful patient selection imperative.
authors.affiliation: Department of Pulmonology, Sint Antonius Hospital, PO BOX 2500, 3430 EM, The, Nieuwegein, Netherlands.
authors.forename: Cordula C M
authors.initials: CC
authors.lastname: Pitz
authors.forename: Aart
authors.initials: A
authors.lastname: Brutel de la Rivière
authors.forename: Henry A
authors.initials: HA
authors.lastname: van Swieten
authors.forename: Cees J J
authors.initials: CJ
authors.lastname: Westermann
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.forename: Jules M M
authors.initials: JM
authors.lastname: van den Bosch
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome