title: Outcome and prognostic factors of resected non-small-cell lung cancer invading the diaphragm.
abstract: OBJECTIVE
  Diaphragmatic infiltration by non-small-cell lung cancer (NSCLC) is a rare occurrence and surgical results are unclear. We assessed our experience with en bloc resection of lung cancer invading the diaphragm, analysing prognostic factors and long-term outcomes.
  
  
  METHODS
  We analysed a prospective database of patients with NSCLC infiltrating the diaphragm who underwent en bloc resection. Univariate analysis was performed to identify prognostic factors. Survival was calculated by the Kaplan-Meier method.
  
  
  RESULTS
  Nineteen patients (14 men, mean age 64 ± 11 years) were identified. Surgery included nine pneumonectomies, eight lobectomies and two segmentectomies. A partial diaphragmatic infiltration was observed in 10 patients (53%) and full-depth invasion in 9 (47%). Diaphragmatic reconstruction was done primarily in 13 patients (68%), and by prosthetic material in 6 (32%). Pathological nodal status included nine N0, four N1 and six N2. The median hospital stay was 7 days (range, 4-36 days). The postoperative mortality rate was 5% (1/19). Two patients (10%) had major complications (acute respiratory distress syndrome and bleeding) and 10 minor complications, arrhythmia in 7 (37%) and pneumonia in 3 (16%). The 5-year survival was 30 ± 11%. The median survival and disease-free survival were 15 ± 9 months (range, 1-164 months) and 9 ± 7 months (range, 1-83 months), respectively. Factors adversely affecting survival were diaphragmatic infiltration (50% superficial vs 0% full-depth infiltration; log-rank test, P = 0.04) and nodal involvement (43% N0 vs 20% N1-2; log-rank test, P = 0.03).
  
  
  CONCLUSIONS
  Resection of NSCLC invading the diaphragm is technically feasible and could be a valid therapeutic option with acceptable morbidity and mortality and long-term survival in highly selected patients.
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy mimgaletta@yahoo.com.
authors: Domenico
authors: D
authors: Galetta
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors: Alessandro
authors: A
authors: Borri
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors: Monica
authors: M
authors: Casiraghi
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors: Roberto
authors: R
authors: Gasparri
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors: Francesco
authors: F
authors: Petrella
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors: Adele
authors: A
authors: Tessitore
authors: Division of Pulmunology, Cardinal Massaia Hospital, Asti, Italy.
authors: Maria
authors: M
authors: Serra
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors: Juliana
authors: J
authors: Guarize
authors: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy University of Milan School of Medicine, Milan, Italy.
authors: Lorenzo
authors: L
authors: Spaggiari
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Diaphragm; Lung cancer; Surgery