[Surgery of primary bronchial cancer. Different types of excisions: technical problems, follow-up results--status of pneumonectomies extended to the carina and bronchial resection-anastomoses].

Surgery is the best solution for primary lung cancer. Surgery must be very large when necessary and must be as limited as possible when pulmonary function is poor. Surgery obtains the best results in primary lung cancer but must be associated with adjuvant therapy when necessary and specially in N2 tumors. In our experience in Marie Lannelongue Center we operated 5890 primary lung cancers between 1966 and 1987 (2255 lobectomies and 2240 pneumonectomies). Our long-term results are 38% at three years and 31% at five years. Extended surgery has been done in many patients. Chest wall resection is used when necessary associated to the lung resection. Carina resection must be used also if necessary. In our experience of 46 pneumonectomies with carina resection the five-year survival is 20% and 41% only for the N1 tumors. When there is involvement of the mediastinal ipsilateral nodes we try to do surgery as often as possible (mediastinoscopy is used very routinely now). On 284 N2 primary lung tumors operated between 1982 and 1988 the five-year actuarial survival is 18%. When the pulmonary function is poor we perform lung lobectomies with sleeve resection (114 sleeve resections on the 2255 lobectomies). The postoperative morbidity and mortality is very low in our experience, and the five-year survival is very good (about 40%).