PURPOSE: Long term results and prognosis after en-bloc resection by the same surgical team were analysed in 251 patients with primary lung tumors invading the chest wall.
METHODS: From 1984 to 2008 the males were 209, and 42 females, with a 62.95+8.74 year-old mean age. Twenty-eight cases have been submitted to radiotherapy and/or neo-adjuvant chemotherapy. All patients received an en-bloc resection with ribs and lung plus ilo-mediastinal lymphadenectomy: 167 lobectomies, 9 bilobectomies, 14 pneumonectomies and 61 sublobar resections. There was an average of 2.73+0.98 removed rib segments always with macroscopically free-disease resection margins.For 96 patients it is not necessary a repair; the others 155 were submitted to reconstruction of the chest wall with alloprosthesis: 104 prolene nets; 40 patches of PTFE; 11 sandwich with acrylic-prolene net. There were 129 adenocarcinomas, 89 squamous carcinomas, 22 large cell carcinomas, 4 mucoepidermoid carcinomas, 3 SCLC, 2 neuroendocrine tumors and 2 BACs.
RESULTS: The post-operative complications have been 6.8% (17/251).The pre-operative staging results to be accurate bringing to the surgery the 65% of the N0 patients. Also 4 among the tumors classified to the stage IIIB (for multifocal T4 in the same lobe) were N0.Chest wall radiation was performed in the 22 microresidual (R1) disease patients and mediastinal radiation in 49 N1, adjuvant chemotherapy and/or mediastinal radiation in the 12 N2.No local recurrence occurred. The chest wall margins were read as close in 16 and the R1 were in 6. Both had a similar survival of R0. Distant recurrences occurred in 185/251 patients in the follow-up with range 12-102 months. Histotype was not recurrence-related. Brain metastases 37; hepatic 34; lung 34; bone 25; adrenal 6; others 9; and multiple lesions 40.
CONCLUSION: The 5 year-survival of the T3N0M0 (stage IIB with T4N0 multifocal disease in the same lobe) was 44.6% and 22.3% in the T3N1 and even more worse in T3N2 (8.4%).
CLINICAL IMPLICATIONS: Postoperative complications are least, radical resection is desirable and a microresidual margin disease don’t worse the prognosis.
DISCLOSURE: Cosimo Lequaglie, No Financial Disclosure Information; No Product/Research Disclosure Information