**8. Results from literature review**

Unfavourable outcome is due to incomplete resection and life-threatening complications Current reports are quoting peri-operative mortality not higher than for any other lung resection [16, 17].

The prognosis of this tumour remained poor until 1961 when Shaw et al [38] reported their satisfactory experience with a bi-modality treatment based on preoperative radiotherapy followed by surgery through a posterior thoracotomy approach. Several other reports [2, 10, 19, 29, 38-41] confirmed that 5-year survivals of approximately 10 to 35% could be achieved with this combined approach, which became the standard treatment. Although radiotherapy was performed prior to surgery in most series, in the experience of others [24, 26]it was often carried out postoperatively.

Adverse prognostic factors are including the presence of mediastinal nodal metastases (N2 disease), spine or subclavian-vessel involvement (T4 disease), and limited resection (R1 or R2) [42-44]. Along the same lines Ginsberg et al [2] found Horner's syndrome, N2/N3 disease, T4 disease and incomplete resection, in general, to be adverse prognostic factors. Okubo and associates [29][16] found that incomplete resection particularly tumour invasion to the brachial plexus, influenced the prognosis.
