An appraisal of en bloc resection of peripheral bronchogenic carcinoma involving the thoracic wall.

Thirty-two patients with peripheral bronchogenic neoplasms adherent to the chest wall underwent en bloc pulmonary and thoracic wall resections. Presenting symptoms were thoracic wall pain (75 percent), hemoptysis (12.5 percent), and cough with weight loss (12.5 percent). Patients were selected for surgical resection only after a search for metastatic disease, including mediastinoscopy, showed negative results. A standard posterolateral thoracotomy incision was used which did not require skeletal reconstruction or prosthetic material for closure. There were nine major postoperative complications (28.8 percent), principally respiratory, and one operative death (3.1 percent). The five-year actuarial survival was 35 percent. None of the patients with regional lymph node involvement or positive chest wall margins lived more than two years after surgery. Preoperative irradiation performed in 12 patients (37.5 percent) improved operability, but did not significantly alter survival. These results indicate that patients with peripheral bronchogenic carcinoma involving the thoracic wall may be successfully managed with en bloc pulmonary and chest wall resection, particularly if surgery is performed in the early stage of the disease.