Surgery

Prior to surgery, the doctor carefully assesses and stages the cancer. Some patients may receive preoperative irradiation of 30 Gy (3000 rad) over 2 weeks. After a 2- to 4-week interval, the doctor surgically removes the chest wall, lower brachial plexus, and the entire lung. The survival rate associated with this procedure is 30% at 5 years.
 
All persons with Pancoast tumors that are directly invading the parietal pleura (covering of the lung) and chest wall should undergo surgery, provided that (1) the cancer is not spreading to distant parts of the body, (2) the patient’s cardiopulmonary status indicates that the patient can undergo surgery, and (3) no preoperative evidence of extensive mediastinal adenopathy (lymph node enlargement) exists. In most patients, the doctor removes the chest wall, lower brachial plexus, and the entire lung. The patient’s outlook is then dependent on the status of his or her lymph nodes.
 
Occasionally, persons with severe pain who are inoperable may be selectively considered for palliative surgery.