From May 1988 to June 1994, 373 patients underwent exploratory thoracotomy for resection of nonsmall cell lung cancer, and 48 patients staged pathologically as IIIB were analyzed. T4 lesions were involvement of great vessel(n=26), heart(n=5),
ipailateral lung metastasis(n=4), esophagus(n=4), carina(n=3), mediastinum(n=2), trachea(n=1), spine(n=1) and pleural seeding seeding(n=15). N3 lesions were involved in 6 patients. Extended pulmonary resection with radical mediastinal node
dissection
was possible in 25 patients, and exploration only was performed in 23 patients. The most frequent cause of unresectability was pleural seeding. Postoperative morbidity was 32%(8/25)and mortality was 16%(4/25) in resected group. The adjuvant
therapy
was
given to 37 patients. The 1 year and 3 year survival for resected group including operative deaths was 57.2%, and 23.8%(median 15 months), but 48.4%, and 0%(median 7 months) for exploration only group(Log-Rank test, P=0.17).
Our results suggest that extended pulmonary resection might be helpful for carefully selected patients with T4 non-small cell lung cancer, but meticulous preoperative work-up for staging, especially to detect pleural seeding and invasion to the
mediastinal structures is a prerequisite to avoid unnecessary thoracotomy.
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