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A Journal on Surgery

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Chirurgia 1999 April;12(2):107-10


language: English

Locally advanced lung tumors: personal experience

Monaco M., Carditello A., Barone M., Panté S., Ciccolo A., Versaci A., Cappuccio S., Mondello B.


Background. On patients with pulmonary neoplasm, locally advanced T3 tumors represent a fertile ground, in which demolition/surgery could reach percentages of fairly encouraging curability without any meaningful increase in mortality and operative morbility. Experience of the last 7 years on locally advanced tumours is reviewed in an attempt of define the factors influencing operative strategy and long-term prognosis.
Methods. From 1989 to 1995, 41 patients with locally advanced non small cell carcinoma underwent surgical treatment. All cases were in stage IIIA. In 30 cases (73.2%) the thoracic wall was involved; in 11 (26.8%) the tumor entered the diaphragm, the pleura and/or the pericardium. 25 patients (61%) underwent lobectomy; 14 (34.1%) wedge resection; 2 (4.9%) bilobectomy. In 33 cases (80.5%) a complete resection was possible; in the other 8 (19.5%) resection was incomplete. Histologically, 20 squamous carcinomas (48.8%), 18 adenocarcinomas (43.9%) and 3 large cell carcinomas (7.3%) were found.
Results. Seventeen patients underwent follow-up for 5 years; 3 with invasion of the diaphragm and mediastinal pleura; 14 with invasion of the thoracic wall. The mean survival reaches 35%.
Conclusions. The review of our series shows an important factor which seems to influence the prognosis of locally advanced lung tumours: the frequent absence of mediastinic limph-node involvement of the neoplasias which invade the thoracic wall. Exactly the opposite situation seems to show that neoplasms that invade the pericardium, diaphragm and mediastinal pleura, present a lymphnodal mediastinal involvement that can reach 68%: this last factor may significantly compromise the long-term survival of these patients.

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