| Abstract
| - From 1969 to 1986, 97 patients with chest wall invasion by lungcarcinoma (excluding superior sulcus tumours) underwent surgical resectionin two hospitals, La Paz (Madrid) and La Fe (Valencia). The same surgicalpolicy was used in both thoracic surgical units: extrapleural pulmonaryresection when tumour involved only the parietal pleura (N = 36), and enbloc chest wall resection when the carcinoma extended into the ribs andintercostal muscles (N = 61). The tumour histology was classified accordingthe WHO criteria. Lobectomy or bilobectomy was carried out in 72%,pneumonectomy in 18% and segmentectomy or wedge resection in 10% of thepatients. The perioperative mortality was higher in the en bloc resectiongroup 9/61 (15%) versus 2/36 (6%) for extrapleural dissection. The nodestaging was NO in 58/97 (60%), N1 in 16/97 (16%) and N2 in 23/97 (24%). Theprobability of survival was calculated by the Kaplan-Meier methodcollecting data from the perioperative survivors only. The overall 5- yearsurvival was 23% with no significant differences between the en blocresection and the extrapleural lung resection groups. The most importantpredictor of survival was the node stage. The 5-year survival for N1 and N2were 8% and 6%, respectively. These percentages increased to 34% when N0patients were considered. Other predictors of survival were notsignificant. The authors conclude that either extrapleural or en bloc chestwall resection are both valid procedures which may be used depending on thedepth of local invasion.
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