Lung Nsclc T3n0


  • chest wall: Because of the inability to precisely define the extent of chest wall invasion at the time of surgery and the low morbidity of chest wall resections in experienced hands// en bloc removal of ribs and intervening musculature// is standard of care for local control of these tumors. Complete resection: 50% 5-year survival.
  • diaphragm: Tumors invading the diaphragm frequently spread along the diaphragmatic pleura; because of this, most patients present with a malignant pleural effusion (T4) indicating incurable disease. In rare instances, however, tumors with direct focal diaphragmatic invasion may be amenable to lobectomy with en bloc resection and reconstruction of the diaphragm. If complete resected 40% cure. No indication for XRT
  • mediastinum: Invasion of the mediastinal pleura, pericardium, or mediastinal fat may occasionally be seen in lung cancer patients. In many instances, en bloc resection of the involved mediastinal tissue can accomplish a complete resection; however, the results of surgery for these lesions are not well known, because most tumors with mediastinal invasion also involve major vascular structures (T4) as well as mediastinal lymph nodes.
  • < 2 cm from carina: pneumonectomy vs parenchyma-preserving operations (sleeve lobectomy) using bronchoplastic or angioplastic techniques are preferable alternatives. Studies indicate that SL yields survival rates and quality of life comparable to if not better than those obtained by standard pneumonectomy. If completely resected 50% 5-year OS
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