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The Annals of Thoracic Surgery, Vol 34, 684-691, Copyright © 1982 by The Society of Thoracic Surgeons
JM Piehler, PC Pairolero, LH Weiland, KP Offord, WS Payne and PE Bernatz
Sixty-six patients (54 men and 12 women) with primary bronchogenic
carcinoma and documented chest wall invasion underwent en bloc chest wall
and pulmonary resection at the Mayo Clinic between January 1, 1960, and
January 1, 1980. Ages ranged from 36 to 85 years, with a mean of 62.2.
Forty-eight lobectomies, 16 pneumonectomies, and 2 wedge excisions were
performed. After operation, 31 patients were classified as T3 N0 M0, 7 as
T3 N1 M0, and 12 as T3 N2 M0. In 16 patients, the N classification could
not be determined (T3 Nx M0). Operative mortality was 15.2%. Actuarial
five-year survival (Kaplan-Meier method) of the 56 patients surviving
operation was 32.9%. Five-year survival for patients with T3 N0 M0
neoplasms was 53.7%; five-year survival for patients with N1 and N2
neoplasms was only 7.4% (p = 0.001). The effect of various factors on
survival, both singularly and in combination, was assessed by Cox's
proportional hazards model. Only age had a significant association with
survival. Among patients with T3 N0 M0 neoplasms, five- year survival was
84.6% for those 60 years of age or less and 27.7% for patients who were
older than 60 years (p = 0.009). We conclude that en bloc resection for
primary bronchogenic carcinoma with chest wall invasion, while associated
with a significant mortality, can be performed with a strong likelihood of
long-term survival if regional lymph nodes are not metastatically involved
and there is no evidence of distant metastasis.
ARTICLES
Bronchogenic carcinoma with chest wall invasion: factors affecting survival following en bloc resection
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