Introduction :

Non-small cell lung cancer (NSCLC) with chest wall involvement accounts for 5% of resectable tumors. Involved structures may be the rib cage, the diaphragm or the spine. Indications and timing of surgical resection in these cases are controversial. The aim of our study was to identify the specificities of the management of NSCLC with chest wall involvement.

Methods :

We retrospectively reviewed the records of 69 patients treated for NSCLC with chest wall involvement between January 2010 and December 2020.

Results :

The mean age was 59.7 years. All patients were smokers with a median of 50 packets per year. Chest pain was the main complaint in 84.1% of the cases. Discovery was fortuitous in 4.3%. Chest CT showed costal involvement with lysis in 62.1% and parietal pleural invasion in 36.2% of the cases. The diaphragm was involved in 4.35%. Parietal and vertebral involvement was noticed in 11.59%.

Parenchymal resection was enlarged to involve : the ribs in 84%, the ribs and vertebrae in 11.6% and the diaphragm in 4.4% of the cases. Lobectomy was performed in 58 cases (84%), a pneumonectomy in 7 cases (10%) and a bilobectomy in 4 cases. The postoperative course was uneventful in 36 cases (52.2%). The duration of drainage was statistically correlated to smoking intoxication(p = 0.008). During follow-up, 3 patients presented parietal recurrence and 2 patients presented distant metastases. Overall survival at 5 years was 62%.

Conclusion :

Surgical resection of NSCLC with chest wall involvement is a heavy procedure, burdened with significant morbidity and mortality. Therefore, the surgical tactics must be well studied according to the patient?s comorbidities and tobacco intoxication.