Survival after extended resection for lung cancer : lessons learned on 167 consecutive cases

purpose: Extended resections for NSCLC may improve survival in selected patients. However, the analysis on large series is still lacking. We reviewed our experience in order to identify prognostic factors usefull for patient's selection. methods: Between 1998 and 2010, 167 patients with one or more mediastinal organ involvement underwent surgery with the intent-to-perform extended resection. At thoracotomy 25% (42pts) were considered unresectable (exploratory thoracotomy – ET) and 75% (125 pts) underwent extended resection (ER). The types of ER were SVC in 43 (34,4%) patients, carina in 33 (26,4%), 18 (14,4%) combined with SVC, left atrium in 35 (28%), and aorta in 14 (11,2%). We excluded Pancoast tumors and vertebral resections. The minimum follow-up was 6 months. Kaplan Meier method and log rank tests were used for statistical analysis of survival. Results: There were 136 male (81.4%) with mean age of 63 years (36-81). Induction chemotherapy was administered in 71.3% (119/167): 34 (81%) patients of ET and 85 (68%) of ER, respectively. Complete resection (R0) was achieved in 106 patients (84.8%). There were 70 (56%) pT4 disease, 18 (14,4%) pN0, 54 (43,2%) pN1, 49 (39.2%) pN2 and 4 (3.2%) pN3. The overall 5-yr survival was 23% (27% in ER and 13% in ET). The overall 30-day mortality and morbidity were 4.8% and 34.1% respectively. Factors affecting survival were complete resection (p<0.01), Stage 0-I-II disease (p< 0.0007), and age less than 60-yr (p<0.01). Conclusions: Radical surgery for NSCLC can improve long term survival (46% at 5- yr in pN0). The best surgical candidates are young patients who have undergone radical resection without lymph node involvement. Multimodality treatment is suggested in case of mediastinal lymph node involvement.