Results of primary surgery with T4 non-small cell lung cancer during a 25-year period in a single center: the benefit is worth the risk

Ann Thorac Surg. 2008 Oct;86(4):1065-75; discussion 1074-5. doi: 10.1016/j.athoracsur.2008.07.004.


Background: The purpose of this study was to assess operative mortality, morbidity, and long-term results of patients with surgically resected T4 non-small cell lung carcinoma.

Methods: A retrospective review of 271 patients with T4 non-small cell lung carcinoma between 1981 and 2006 was undertaken. They were divided into four subgroups: 126 patients with superior sulcus tumors, 92 with carinal involvement, 39 with superior vena cava replacement, and 14 with the tumor invading other mediastinal structures. There were 221 men and 50 women with a mean age of 56.3 years. Resection was complete in 249 (92%) patients. The pathologic N status was N0/N1 in 208 and N2/N3/M1 in 63 patients.

Results: Operative mortality and morbidity rates were 4% and 35%, respectively. Overall 5-year survival rate was 38.4%. It was 36.6% for superior sulcus tumor, 42.5% for carinal involvement, 29.4% for superior vena cava replacement, and 61.2% for mediastinal group. By multivariate analysis, only three factors influenced survival: nodal status (N0/N1 versus N2/3/M1; 43% versus 17.7% at 5 years, respectively; p = 0.01), complete resection (R0 versus R1; 40.4% versus 15,9%, respectively; p = 0.006), and invasion of the subclavian artery (with versus without invasion; 24.9% versus 41.7%, respectively, p = 0.02).

Conclusions: In highly qualified centers, radical surgery of T4 N0/N1 non-small cell lung carcinoma can be performed with a 4% mortality rate and may yield a 43% 5-year survival rate. These results seem to indicate primary surgery as the treatment of choice for T4 non-small cell lung carcinoma, whenever a complete resection is thought to be technically feasible and the patient's condition is compatible with the extent of the planned surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Cohort Studies
  • Disease-Free Survival
  • Education, Medical, Continuing
  • Female
  • Humans
  • Immunohistochemistry
  • Kaplan-Meier Estimate
  • Logistic Models
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Invasiveness / pathology*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Staging
  • Pneumonectomy / methods
  • Pneumonectomy / mortality
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome