The coin lesion story: update 1976. Twenty years' experience with thoracotomy for 179 suspected malignant coin lesions.

We reviewed 179 patients who had undergone thoracotomy and resection of a suspected malignant coin lesion of the lung over the past 20 years to see if a policy of early thoracotomy was therapeutically valid. The average diameter of all lesions was 1.6 cm; the average diameter of 27 malignant lesions (15 percent) was 1.8 cm. Follow-up of the 27 patients with malignant neoplasms was 100 percent. The present survival rate of the 19 patients with primary lung cancer is 89 percent (17/19). Of 12 cases of primary lung cancer followed for five years, ten (83 percent) survived. The five-year survival of the eight patients with metastatic lesions was 25 percent (2/8). There were no postoperative deaths and few serious postoperative complications (four patients or 2 percent). Very small primary lung cancers detected and treated early do have the same poor prognosis as larger primary cancers.