Abstract

Objective: The aim of this work was to study the surgical management of patients with non-small cell lung carcinomas (NSCLC) with chest wall invasion of stage IIB (T3N0M0) or IIIA (T3N1M0), and to compare this with another group of patients of the same oncologic criteria not offered surgery.

Methods: The patients were divided into two groups. Group I; included 15 patients treated by lung and chest wall resection. To demonstrate the benefits of surgery for this group of patients, a comparison was made with another group of 20 patients (Group II) with stage IIB (T3N0M0) or IIIA (T3N1M0) NSCLC with chest wall invasion for whom a non-surgical protocol of multimodality therapy utilizing radiotherapy and chemotherapy was adopted.

Results: In group I, wedge resection was done for one patient (6.67%), lobectomy for 12 patients (80%), bilobectomy for one patient (6.67%) and pneumonectomy for one patient (6.67%). The number of ribs resected varied from 2--4 (mean 2.93). Only two patients required skeletal reconstruction using prolene mesh. One patient (6.67%) died three weeks postoperatively of respiratory failure. The major postoperative complications included residual pocket in two cases (13.3%) requiring localized thoracoplasty and prolonged air leak for more than 10 days in two patients (13.3%) requiring prolonged tube drainage.

In group II, there were two complete responses (CR) and 13 partial responses (PR) in the radiation field, for a response rate of 75%. The relapse pattern was predominately locoregional (65%). Major acute toxicity (=>grade 3) included 13 patients (65%) with leukopenia, seven patients (35%) with thrombocytpenia and one patient (5%) with oesophagitis. One possible treatment-related death due to diffuse pneumonitis was observed (5%).

Group I had an actuarial one-year survival of 78%, 2-year survival of 44% and 3-year survival of 30% compared to 60%, 35% and 0% respectively for group II. The differences were statistically significant. No patients in group II survived more than 2.5 years. The survivors of Group I patients experienced less pains and had a better quality, of life than group II patients.

Conclusions: It was concluded that lung and chest wall resection for this group of patients with stage IIB or IIIA NSCLC can be done with acceptable mortality and morbidity. It is also attended with improved survival and quality of life.