320SURGICAL TREATMENT OF SUPERIOR SULCUS TUMOURS: A FIFTEEN-YEAR SINGLE-CENTRE EXPERIENCE

Objectives: To analyse characteristics and outcome of patients with superior-sulcus tumours who underwent surgery over a period of 15 years at one institution. Methods: Clinical records of 94 consecutive cases operated on by the same surgical team for NSCLC between July1998 and December 2013 were reviewed retrospectively. Results: Seventy-nine (84%) were men, median age was 62 years. Surgery was anterior approach in 45 patients (47.9%), Paulson incision in 39 cases (41.5%) and combined approach in 10 (10.6%). Forty-eight (51%) received induction treatments. Resections were 78 lobectomies (83%), 3 pneumonectomies (3%), 6 bronchoplastic reconstruction (6.5%) and 7 wedge resections (7.5%). In 96%, nodal dissection was systematic (hilar-mediastinal including supra-clavicular lymph nodes in case of anterior approach). Median number of resected ribs was 2, chest wall defect was reconstructed in 42 cases (44.6%); 21 patients had an associated vascular resection (22.5%). Resection was radical in 85 cases (90.4%). Overall mortality was 9.6% (n = 9) (leading cause of death, acute respiratory distress syndrome). Mortality was 1.1% for posterior approach, 6.4% for anterior approach and 2.1% for combined. After median follow-up of 1.9 years, 32 patients were alive (34%), 4 with relapse. The 5- and 10-year overall survivals were 35% and 23%, respectively. Significantly lower 5-year survival was observed in patients with nodal disease (48.9% in N0 vs 16.9% in N+), after incomplete resection and in anteriorly located tumours (anterior versus posterior: 25% vs 49% at 5 years). Conclusion: Pancoast tumour is a severe condition but long-term survival may be achieved in selected cases; nodal involvement and completeness of resection are the most important factors; induction treatment might play a role.