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Non-small Cell Lung Cancer With Chest Wall Invasion^*

Evolution of Surgical Treatment and Prognosis in the Last 3 Decades

^* From the Department of General Surgery, University of Milan, San Giuseppe Hospital FbF-A. Fa. R., Milan, Italy.

Correspondence to: Giancarlo Roviaro, MD, FCCP, Head, Department of General Surgery, University of Milan, San Giuseppe Hospital FbF-A. Fa. R., Via San Vittore, 12, 20122 Milano, Italy; e-mail: gian.roviaro{at}unimi.it

Study objectives: The treatment of patients with non-small cell lung cancer (NSCLC) that is invading the chest wall is still debated. We aim to illustrate the improvements in treatment results that have occurred over last decade.

Design: Retrospective analysis of our experience and an overview of the literature.

Setting: Department of Surgery, San Giuseppe Hospital, University of Milan.

Patients: From January 1970 to December 1999, of 2,738 patients with NSCLC, we operated on 146 patients (5.4%) with chest wall invasion by NSCLC. Superior sulcus tumors and tumors invading the diaphragm or mediastinum were excluded. We reclassified all cases according to the current TNM classification.

Results: We registered one postoperative death (0.69%) and five major complications (3.4%). From 1970 to 1979, of 32 patients, 10 underwent an exploratory thoracotomy (ET) and 22 underwent a radical resection (stage IIB disease, 17 patients; stage IIIA disease, 5 patients). The 5-year survival rate was 22.7% (25% for stage IIB disease). From 1980 to 1989, of 67 patients, 11 underwent an ET and 56 underwent a radical resection (stage IIB disease, 34 patients; stage IIIA disease, 12 patients; stage IIIB disease, 5 patients; and stage IV disease, 5 patients). The survival rate following radical resection was 14.1%, ranging between 23.5% for patients with stage IIB disease and 0% (3 years, 14%) for those with stage IIIA disease. From 1990 to1999, of 47 patients, 2 underwent an ET, 2 underwent an exploratory thoracoscopy, and 43 underwent a radical resection (stage IIB disease, 23 patients; stage IIIA disease, 20 patients). The survival rate was 42.7% (stage IIB disease, 78.5%; stage IIIA disease, 7.2%).

Conclusions: Considering the low morbidity, mortality, and significant improvement in survival during the last decade, we advocate the performance of radical en bloc resection for the treatment of chest wall invasive NSCLC.

Key Words: chest wall invasion • lung cancer • surgical treatment • survival

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