[Surgical treatment of lung cancer with chest wall invasion].

From 1955 through 1987, 64 cases underwent operation at Mie University Hospital for carcinoma of the lung invading the chest wall (p-T3). According to the classification by Mishina et al, the extent of tumor invasion of the chest wall was p3a-b in 63%, p3c in 18%, and p3d in 19%. Histologically, the tumors were epidermoid carcinoma in 565, adenocarcinoma in 31%, large cell carcinoma in 11%, and small cell carcinoma in 2%. The post surgical staging of N factor was N0 in 39%, N1 in 33%, and n2 in 28%. Extrapleural resection was performed in 27 cases and extended resection (en block resection of chest wall and lung) was performed in 30 cases with an operative mortality of 0%. The actuarial three-year survival rate (Kaplan-Meier method) for patients with p3d was 18.2% but three-year survival for patients with p3a-b and p3c was more than 30%. In spite of p3a-b, however, four-year survival for patients without extended resection was decreased to 11.6%. Four-year survival of patients with adenocarcinoma, epidermoid carcinoma, and large cell carcinoma was 5.9%, 28.4% and 75% respectively, lymphatic metastases reduced survival, with a three-year survival rate of 52.8% for patients with N0 disease and 8.35 for those with N2 disease. Among patients with extended resection, four-year survival for patients 60 years of age of less was 50.8%, greater than the 13.3% four-year survival for the patients more than 61 years of age. We conclude that long-term survival can be influenced by the extent of tumor invasion. In factor, histologic type, and the patient's age, and that extended resection and adjuvant therapy should be applied for treatment of lung cancer with chest wall invasion.