Pii: S1010-7940(01)00735-7

Objective: To retrospectively assess the results of surgical treatment in a consecutive series of 110 patients with Stage IIb and IIIa non small cell lung cancer (NSCLC) invading chest wall. Methods: A series of 110 patients underwent surgery for Stage IIb and IIIa NSCLC with involvement of chest wall. There were 101 male and 9 female patients, mean age was 61.4 (range 32±74), 52 (47.3%) of them complaining for chest pain. Surgical procedures were pneumonectomy in seven patients (6.4%), lobectomy in 73 (66.4%), bi-lobectomy in six (5.4%) and wedge resection in 24 (21.8%). In 63 patients (57.3%) an extrapleural resection was performed while in the other 47 (42.7%) an `en bloc' resection of tumor with chest wall was required. In 22 patients (76.3%) repair was achieved by muscle ̄ap while in 8 (26.7%) a prosthesis was required. Five-year survival was computed using the Kaplan±Meier method; P values correspond to the log-rank test. Results: There were neither intraoperative nor postoperative deaths. Postoperative staging revealed 83 T3N0M0, 17 T3N1M0 and 10 T3N2M0. Mean postoperative hospital stay was 17.7 days (range 5±40). For N0 patients 5 year survival was 47% (39/83) and no signi®cant difference was noted when extrapleural and `en bloc' resection groups were compared (P ˆ 0:08). In N1/N2 patients no survival was observed (0/27) and comparison between surgical procedures was not statistically signi®cant (P ˆ 0:41). Moreover when N0 patients were compared with N1 patients the difference in survival was signi®cant for both extrapleural (P ˆ 0:02) and `en bloc' (P ˆ 0:04) groups. No difference was noted when the two surgical procedures were compared independently form N status (P ˆ 0:94).Within the group of patients undergone `en bloc' resection survival was signi®cantly better for N0 patients as in the group of extrapleural resection. Conclusion: Surgical treatment of Stage IIb and IIIa NSCLC invading chest wall by extrapleural or `en bloc' resection is widely adopted and justi®ed by the good results in terms of morbidity and relief of pain. Survival is always depending on the N status. q 2001 Elsevier Science B.V. All rights reserved.