The role of surgery in the management of lung cancer with pleural dissemi- nation is controversial. We performed a retrospective analysis of our pa- tients with lung cancer and pleural dissemination who were treated surgi- cally. Between 1973 and 1993, 1,206 patients with lung cancer underwent pulmonary resection at Kanazawa University Hospital. Among them, 40 (3.3%) had pleural dissemination without pleural effusion. The 1-, 3-, and 5-year survival rates for 38 patients (except 2 patients undergoing exploratory thoracotomy alone) were 5 1.5%, 19.4%, and 19.4%, respec- tively. The 1-year survival rate in the 10 patients who underwent pleuro- pneumonectomy was only 20%, and 9 of these patients died within 18 months postoperatively (1 patient has survived for 25 months). In contrast, the 1-, 3-, and 5-year survival rates for the 14 patients who underwent resection of the primary tumor plus parietal pleurectomy were 85.1%,35.5%, and 35.5%, respectively, a significantly better outcome ( P <= 0.01). Seven patients are still alive (the longest survival time is 65 months with the disease). The average survival time in the seven fatal cases was 18 months. In patients with lung cancer accompanied by pleural dissemination, it is quite possible that local excision plus pleurectomy will be justified.
Lung cancer associated with carcinomatous pleurisy is generally already near the terminal stage. There are usu- ally no indications for surgery, so conservative treatment is provided, chiefly to control the patient’s pleural effu- sion [ 1-33. In some cases, however, carcinomatous pleu- risy is found at the stage of pleural dissemination alone without pleural effusion. Unfortunately, it is difficult to achieve the complete resection of lung cancer accompa- nied by pleural dissemination, so the prognosis is usually poor even when patients are treated surgically. In addition, there is still controversy regarding the optimal operative procedure for lung cancer with pleural dissemination.
Accordingly, we evaluated the effect of extending the operative procedure by comparing the results of extended and limited surgery.