title: Surgery for metastatic pleural extension of non-small-cell lung cancer.
abstract: OBJECTIVE
  Malignant cells in the pleural fluid or pleural metastases are now classified stage IV in lung cancer and alter the treatment. Our purpose was to question the role of surgery in such patients.
  
  
  METHODS
  The clinical records of 4668 patients, who underwent lung cancer surgery, were reviewed. In some, an undiagnosed pleural malignant disease (M1a) was discovered during thoracotomy. When feasible, selected patients underwent complete surgical resection of the primary tumor and pleural nodules. We analyzed the epidemiology, pathology, and prognosis characteristics of that group (study group), as compared with the population undergoing pulmonary resection in a curative attempt (overall population) or exploratory thoracotomy in case of unexpected disseminated carcinomatous pleuritis (control group).
  
  
  RESULTS
  The study group included 32 patients (25 males), mean age 59 ± 8.8 years, who underwent pneumonectomy (n = 9) or lobectomy (n = 23), associated with mediastinal lymph nodes dissection and surgical resection of associated pleural nodules. There were 21 adenocarcinomas, seven squamous cell carcinomas, two undifferentiated large cell carcinomas, and two miscellaneous tumors. Pathological node (pN) was: N0 in 10 patients (31.3%), N1 in four (12.5%), and N2 in 18 (56.3%). Five-year survival rate was 16% after resection, and 21% if the resection was a lobectomy.
  
  
  CONCLUSIONS
  Complete surgical resection of non-small-cell lung cancer (NSCLC) associated with limited metastatic pleural involvement is associated with long-term survival in 16% of the cases. A review of the published data, together with the results of this series, may justify the inclusion of surgery in multimodality treatment of NSCLC patients with metastatic pleural extension.
authors.affiliation: Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, APHP, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mordant
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.forename: Christophe
authors.initials: C
authors.lastname: Foucault
authors.forename: Antoine
authors.initials: A
authors.lastname: Dujon
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000556:secondary* / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome