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Ann Thorac Surg 1999;68:2065-2068
© 1999 The Society of Thoracic Surgeons
a Division of General Thoracic Surgery, Azienda Ospedaliera "E. Morelli," Sondalo (Sondrio), Italy
b Division of General Thoracic Surgery, University "La Sapienza," Rome, Italy
Address reprint requests to Dr Rocco, Via Agricoltura, 20 23037, Tirano (Sondrio), Italy
e-mail: grocco{at}novanet.it
Abstract
Background. Diaphragmatic invasion from lung cancer (T3-diaphragm) is a rare occurrence reported to portend a poor prognosis.
Methods. Fifteen patients with T3-diaphragm (14 males, 1 female; median age, 64 years) were surgically treated over a twenty-year period by en bloc resection (14 patients). One patient was only explored. Pathologic stage IIB (T3N0) was found in 11 patients. A partial infiltration of the diaphragm was observed in 3 patients, whereas full-depth invasion was found in 12. Diaphragmatic reconstruction was done primarily in 9 patients, and, by prosthetic material in 5.
Results. Two patients are still alive without evidence of disease at 88, and, 114 months from surgery. Overall median survival was 23 months (range, 3 to 168). The actuarial 5-year survival was 20%, when all patients were considered, and, 27%, for T3N0 patients. Univariate analysis showed that prosthetic replacement of the muscle (p = 0.018) was significantly related to survival.
Conclusions. T3-diaphragm is best treated with en bloc resections with wide tumor-free margins and prosthetic replacement of the diaphragm.
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