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Hamouri S, Alrabadi N, Syaj S, Abushukair H, Ababneh O, Al-Kraimeen L, Al-Sous M, Hecker E. Atrial resection for T4 non-small cell lung cancer with left atrium involvement: a systematic review and meta-analysis of survival. Surg Today 2023; 53:279-292. [PMID: 35000034 DOI: 10.1007/s00595-021-02446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Extended resection for non-small cell lung cancer (NSCLC) with T4 left atrium involvement is controversial. We performed a systematic review and meta-analysis to evaluate the short- and long-term outcomes of this treatment strategy. METHODS We searched the PubMed database for studies on atrial resection in NSCLC patients. The primary investigated outcome was the effectiveness of the surgery represented by survival data and the secondary outcomes were postoperative morbidity, mortality, and recurrence. RESULTS Our search identified 18 eligible studies including a total of 483 patients. Eleven studies reported median overall survival and 17 studies reported overall survival rates. The estimated pooled 1, 3, 5-year overall survival rates were 69.1% (95% CI 61.7-76.0%), 21.5% (95% CI 12.3-32.3%), and 19.9% (95% CI 13.9-26.6%), respectively. The median overall survival was 24 months (95% CI 17.7-27 months). Most studies reported significant associations between better survival and N0/1 status, complete resection status, and neoadjuvant therapy. CONCLUSION Extended lung resection, including the left atrium, for NSCLC is feasible with acceptable morbidity and mortality when complete resection is achieved. Lymph node N0/1 status coupled with the use of neoadjuvant therapies is associated with better outcomes.
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Affiliation(s)
- Shadi Hamouri
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sebawe Syaj
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Obada Ababneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Leen Al-Kraimeen
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Majd Al-Sous
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Erich Hecker
- Thoracic Surgery Department, Thoracic Center Ruhrgebiet in Herne, Herne, Germany
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Di Tommaso L, Di Tommaso E, Giordano R, Mileo E, Santini M, Pilato E, Iannelli G. Endovascular Surgery of Descending Thoracic Aorta Involved in T4 Lung Tumor. J Endovasc Ther 2023; 30:84-90. [PMID: 35114844 DOI: 10.1177/15266028221075551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Surgical treatment of primary lung T4 tumors is controversial especially when the cancer invades the mediastinal structures or the descending thoracic aorta. Conventional surgical treatment is associated with a high perioperative mortality and morbidity rate. Thoracic EndoVascular Aortic Repair has emerged as a valid off-label alternative to conventional surgery. We aimed to assess perioperative and midterm aortic-related outcome of patients who have undergone aortic stent-graft implantation, followed by en bloc surgical treatment of the involved aorta and lung cancer resection. MATERIALS AND METHODS From July 2017 to May 2020, we treated 5 patients diagnosed with a T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a 2-stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One-stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with the involvement of cardiac and/or other vascular mediastinal structures. RESULTS The mean age was 58.4 ± 6.2 years. All patients were affected by non-small cell lung cancer. All 5 patients required a single stent-graft to completely cover the involved segment of aorta. Four patients underwent a 2-stage procedure. One patient, with the involvement of the left inferior pulmonary vein, required a 1-stage en bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein, and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up, no patient developed aortic-related complications. One patient died 2 years after surgery, due to local recurrence of the tumor. CONCLUSION T4 lung resection combined with aortic stent-graft implantation can be safely performed. Endovascular surgery, by avoiding the use of cardiopulmonary bypass, aortic cross-clamping, and graft replacement, can reduce significant morbidity and mortality rate. Postoperative and long-term outcome of these patients treated with endovascular surgery is mainly related to pulmonary disease, not to aortic treatment.
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Affiliation(s)
- Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Ettorino Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Raffaele Giordano
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Emilio Mileo
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Emanuele Pilato
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Gabriele Iannelli
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
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Galetta D, Spaggiari L. Atrial Resection without Cardiopulmonary Bypass for Lung Cancer. Thorac Cardiovasc Surg 2019; 68:510-515. [PMID: 31679151 DOI: 10.1055/s-0039-1700563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Results of resection of lung cancer invading left atrium (T4atrium) without cardiopulmonary bypass (CPB) remain controversial. We reviewed our experience analyzing surgical results and postoperative outcomes. METHODS Patients who underwent extended lung resection for T4atrium without CPB between 1998 and 2018 were retrospectively reviewed using a prospective database. RESULTS The study included 44 patients (34 males and 10 females; median age: 63 years). Twenty-five patients underwent preoperative mediastinal staging and 27 received induction treatment (IT). Surgery included 40 (90.9%) pneumonectomies, 3 (6.8%) lobectomies, and 1 bilobectomy (2.3%). Pathological nodal status was N0 in 10 patients (22.7%), N1 in 18 (40.9%), and N2 in 16 (36.4%). Four patients receiving IT had a complete pathological response (9.1%). Eight (18.2%) patients had microscopic tumor evidence on atrial resected margins. Mortality was nil. The major complication rate was 11.4%, including one bronchopleural fistula, one cardiac herniation, and three hemothoraces, all requiring reintervention. The minor complication rate was 25.5%. After a median survival of 37 months (range: 1-144 months), 20 (45.4%) patients were alive. Five-year survival rate and disease-free interval were 39 and 45.8%, respectively. Patients with N0 and R0 disease had a best prognosis (log-rank test: p = 0.03 and p = 0.01, respectively). IT neither influenced survival nor postoperative complications. On multivariate analysis, pN0 (p = 0.04 [95% confidence interval [CI]: 0.65-9.66] and negative atrial margins (p = 0.02 [95% CI: 0.96-8.35]) were positive independent prognostic factors. CONCLUSIONS T4atrium is technically feasible without mortality and acceptable morbidity. Patients with N2 cancers should not be operated. T4atrium should not be systematically considered as a definitive contraindication to surgery.
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Affiliation(s)
- Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology-DIPO, University of Milan, Milan, Italy
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Extended pneumonectomy for advanced lung cancer with cardiovascular structural invasions. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:336-342. [PMID: 32082760 DOI: 10.5606/tgkdc.dergisi.2018.15059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the predictive factors in relation to tumor stages, mediastinal involvements, perioperative adjuvant therapies and surgical techniques in advanced lung cancer patients who underwent extended pneumonectomy with cardiovascular structural resection. Methods A comprehensive literature review was performed for extended pneumonectomies with cardiovascular structural resections in the PubMed, Google Scholar and HighWire Press for the year range 2000-2016. Data were carefully extracted regarding details such as the study population, demographics, clinical features, types of lung cancer, pathologic stages, nodal involvement, extent of pneumonectomy, cardiovascular structural resections, use of cardiopulmonary bypass, completeness of resection, pre- and postoperative adjuvant therapies, 1-5-year survival, median survival duration, comorbidity and mortality. Results Patients undergoing extended pneumonectomy with cardiovascular structural resection were characterized more by squamous carcinomas, N0 or N1, T4, stage 3 and left atrial invasions. More patients received postoperative radiochemotherapy than radioor chemotherapy. The five-year survival rate was 30.5±11.5% and the median survival duration was 23.0±10.7 months. Level 1 left atrial, aortic adventitial, and partial superior vena cava resections could be performed without cardiopulmonary bypass, while levels 2 and 3 left atrial resections with aorta or superior/inferior vena cava replacement should be performed under cardiopulmonary bypass. Conclusion The advent of cardiopulmonary bypass facilitated complete resection of lung cancer, while leading to potential risks of metastasis and reoccurrence. Pathological status, surgical techniques and pre- and postoperative adjuvant therapies affect survival significantly. Surgical indications and negative predictive risk factors for patients' survival warrant further evaluations.
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Belov YV, Komarov RN, Parshin VD, Yavorovsky AG, Chernyavsky SV, Mnatsakanyan GV. [Right-sided pneumonectomy with left atrium resection under cardiopulmonary bypass in the patient with lung cancer (the first case in Russia)]. Khirurgiia (Mosk) 2017:78-81. [PMID: 28209960 DOI: 10.17116/hirurgia2017178-81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yu V Belov
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - R N Komarov
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - V D Parshin
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - A G Yavorovsky
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - S V Chernyavsky
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - G V Mnatsakanyan
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
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Xu X, Chen H, Yin W, Shao W, Wang W, Peng G, Huang J, He J. Initial experience of thoracoscopic lobectomy with partial removal of the superior vena cava for lung cancers. Eur J Cardiothorac Surg 2014; 47:e8-12. [PMID: 25404663 DOI: 10.1093/ejcts/ezu416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objectives of this study were to report the surgical techniques and clinical outcome of thoracoscopic lobectomy with partial removal of the superior vena cava for lung carcinomas. METHODS Between January 2010 and November 2013, 1132 patients with lung cancer underwent radical surgery by thoracoscopy; 5 (0.4%) underwent thoracoscopic lobectomy with partial removal of the superior vena cava. Perioperative variables and postoperative outcomes of these cases were analysed to evaluate the technical feasibility and safety of this operation. RESULTS For all cases, a right upper lobectomy was performed. The average time of surgery was 260 min (range, 170-380, 260±90 min).The intraoperative blood loss averaged 160 ml (range, 50-300, 160±90 ml). The median postoperative hospital stay was 11 days (interquartile range, 7-15 days). Postoperatively, tracheal extubation was achieved in the recovery room without further need for mechanical ventilation. In 1 case, the patient experienced postoperative superior vena cava thrombosis; he recovered after administration of anticoagulation drugs. None of the patients developed active blood leakage postoperatively. Perioperative mortality was not observed. CONCLUSION Thoracoscopic lobectomy with partial removal of the superior vena cava can be considered a feasible and safe operation for selected patients with lung cancer.
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Affiliation(s)
- Xin Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Hanzhang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Weiqiang Yin
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Wenlong Shao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Wei Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Guilin Peng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Jun Huang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
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Rivera C, Pricopi C, Borik W, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [pT4 non-small cell lung cancer: Surgical characteristics in present practice]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:214-222. [PMID: 24874406 DOI: 10.1016/j.pneumo.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION pT4 is a group of miscellaneous tumors: our goal was to revisit their surgical reality. METHODS The different characteristics and prognostic factors of lung pT4 (n=403) were analysed according to three subgroups: G1 - by direct extension; G2 - by nodule in other ipsilateral lobe; G3 - because of both. RESULTS There were 332 males and 71 females mean aged 61.5 years. Surgery [exploratory: 89 (22.1 %), lobectomy: 149 (37 %), pneumonectomy: 169 (41.9 %)] was followed by 26 postoperative deaths (6.5 %), 82 complications (20.3 %) and concerned few pN0 (47.6 %). G1 (n=196) and G3 (n=53) were not different. By comparison with them, G2 (n=53) were mainly females (24\13 %), with less explorative thoracotomy (2.6\34 %), more complete R0 resections (77\29 %), less pneumonectomy (31\47 %), more small sized tumors (mean: 37\57 mm), more adenocarcinoma (67\32 %), more N0 tumors (48\31.7 %) and stages IIIA disease (46.7\56 %). G2 5-year survival rates were higher (G2: 22 %; G1: 13 %; G3: 15 %); G1 rates depended of the invaded structure (20.9 % for the vertebra down to 0 % for the esophagus and carina). pN2 rates were not very high but not different between groups (G1: 13.6 %; G2: 15.6 %; G3: 14.3 %; P=0.52). Multivariate analysis demonstrated completeness and type of resection, stage and age as independent factors of prognosis. CONCLUSION Surgery for pT4 is justified provided rigorous selection of extension forms. However, assimilating extension and ipsilateral lobe nodule in a same group does not obey to surgical reality.
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Affiliation(s)
- C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - W Borik
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - A Dujon
- Centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France.
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Pricopi C, Alimi F, Achouh P, Mordant P, Le Pimpec-Barthes F, Arame A, Badia A, Riquet M. [Lung cancer with heart failure--a cardiac and thoracic surgeon's collaboration]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:122-125. [PMID: 24566033 DOI: 10.1016/j.pneumo.2013.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/30/2013] [Accepted: 08/04/2013] [Indexed: 06/03/2023]
Abstract
Surgical resection is a validated therapeutic option for selected cases of pulmonary tumors invading the important mediastinal structures (caval vein, atrium, aorta or supra-aortic trunks). Here, we present a patient with a necrosed pulmonary tumor invading the left atrium, causing cardiac insufficiency. A complete surgical resection under extracorporeal circulation was performed by the thoracic and cardiac teams. Admitted in a bed-ridden state, the patient was discharged completely rehabilitated on postoperative day 13. He survived 1 year at home with a good quality of life.
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Affiliation(s)
- C Pricopi
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Alimi
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Achouh
- Service de chirurgie cardiovasculaire, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Stella F, Dell'Amore A, Caroli G, Dolci G, Cassanelli N, Luciano G, Davoli F, Bini A. Surgical results and long-term follow-up of T(4)-non-small cell lung cancer invading the left atrium or the intrapericardial base of the pulmonary veins. Interact Cardiovasc Thorac Surg 2012; 14:415-9. [PMID: 22269143 DOI: 10.1093/icvts/ivr160] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patients with locally advanced non-small cell lung cancer infiltrating the left atrium (LA) or the intrapericardial base of the pulmonary veins (PVs) are generally not considered good candidates for surgery because of the poor long-term survival. In the last 10 years, 31 consecutive patients with non-small cell lung cancer directly invading the LA or the intrapericardial base of the PVs underwent surgery. Pneumonectomy was the operation performed most frequently. In-hospital mortality was 9.7% and overall morbidity was 52%. One-, 2- and 3-year survival rates were 64, 46 and 30%, respectively with a mean survival of 22 months. The systemic recurrence of disease was the major cause of death at follow-up. At statistical analyses, the N-factor and the type of operation were related to poor long-term survival. In these patients, surgery could be performed with an acceptable operative mortality and morbidity. Surgery should be considered whenever a complete resection is technically possible. A careful preoperative evaluation is mandatory to select good candidates for surgery.
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Affiliation(s)
- Franco Stella
- Thoracic Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Nimmo C, Lyons O, Clough R, Landau D, Routledge T, Taylor P. Novel use of endoluminal repair as prophylaxis of aortic rupture secondary to radiotherapy for lung cancer. J Vasc Surg 2011; 54:1795-7. [PMID: 21890305 DOI: 10.1016/j.jvs.2011.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/31/2011] [Accepted: 06/11/2011] [Indexed: 11/17/2022]
Abstract
Non-small-cell lung cancer (NSCLC) invading the aorta is staged as T(4). Only 9% of T(4) tumors are resected; the alternative is chemoradiotherapy, but for peri-aortic NSCLC, radiation damage to the aortic wall can induce fatal rupture. We report the case of a 76 year-old man with a 3-cm left lower lobe NSCLC clearly invading the aortic wall. A thoracic stent graft was inserted prophylactically to prevent aortic rupture. He then received 64 Gy radiotherapy in 32 fractions, resulting in tumor shrinkage. Prophylactic aortic endografting, a less invasive treatment than open surgery, may enable high dose irradiation of the aortic wall.
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Affiliation(s)
- Camus Nimmo
- King's Health Partners Vascular Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Muralidaran A, Detterbeck FC, Boffa DJ, Wang Z, Kim AW. Long-term survival after lung resection for non–small cell lung cancer with circulatory bypass: A systematic review. J Thorac Cardiovasc Surg 2011; 142:1137-42. [DOI: 10.1016/j.jtcvs.2011.07.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/26/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
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Riquet M, Achour K, Foucault C, Le Pimpec Barthes F, Dujon A, Cazes A. Microscopic Residual Disease After Resection for Lung Cancer: A Multifaceted but Poor Factor of Prognosis. Ann Thorac Surg 2010; 89:870-5. [DOI: 10.1016/j.athoracsur.2009.11.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/17/2009] [Accepted: 11/19/2009] [Indexed: 10/19/2022]
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Shinohara H, Tsuchida M, Hashimoto T, Satoh S, Takeuchi A, Takeshige M, Hayashi JI. Superior vena cava reconstruction via a posterolateral thoracotomy without venous occlusion for locally advanced lung cancer: report of a case. Surg Today 2009; 39:787-9. [PMID: 19779775 DOI: 10.1007/s00595-008-3927-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 07/28/2008] [Indexed: 10/20/2022]
Abstract
We performed a right upper lobectomy with prosthetic replacement of the superior vena cava (SVC) through a posterolateral thoracotomy in a 65-year-old man undergoing complete resection of a locally advanced non-small-cell lung cancer with invasion of the SVC. Instead of using a vascular shunt, the right atrium and a right brachiocephalic vein (BCV) were anastomosed using a ringed polytetrafluoroethylene (PTFE) graft. During the anastomosis, vascular flow was maintained through the left BCV. By using this technique, SVC resection and reconstruction during lung cancer surgery can be safely performed through a posterolateral thoracotomy without blood flow interruption.
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Affiliation(s)
- Hirohiko Shinohara
- Divisions of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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Surgical Treatment of Lung Cancer Invading the Left Atrium or Base of the Pulmonary Vein. World J Surg 2009; 33:492-6. [DOI: 10.1007/s00268-008-9873-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Trends in the Operative Management and Outcomes of T4 Lung Cancer. Ann Thorac Surg 2008; 86:368-74. [DOI: 10.1016/j.athoracsur.2008.04.090] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 04/25/2008] [Accepted: 04/28/2008] [Indexed: 11/22/2022]
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17
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Extended pneumonectomy for non–small cell lung cancer: Morbidity, mortality, and long-term results. J Thorac Cardiovasc Surg 2007; 134:1266-72. [PMID: 17976460 DOI: 10.1016/j.jtcvs.2007.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 12/29/2006] [Accepted: 01/08/2007] [Indexed: 11/21/2022]
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Misthos P, Papagiannakis G, Kokotsakis J, Lazopoulos G, Skouteli E, Lioulias A. Surgical management of lung cancer invading the aorta or the superior vena cava. Lung Cancer 2007; 56:223-7. [PMID: 17229487 DOI: 10.1016/j.lungcan.2006.12.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 10/02/2006] [Accepted: 12/12/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Invasion of mediastinal structures (T4) is considered as an absolute contraindication to surgical management of non-small cell lung cancer (NSCLC). The authors studied the role of surgical treatment in case of direct aortic and superior venous caval involvement. PATIENTS From 1995 to 2000, 13 patients with left lung NSCLC invading descending aorta and 9 patients with right upper lobe NSCLC and superior vena cava (SVC) invasion were subjected to thoracotomy for lung resection. Surgery was indicated in case of absence of intraluminal extension. All patients were cN2 negative. The pathology results and 5-year survival were recorded and analyzed. RESULTS In three cases (23%) the tumor was adhered to the parietal pleura overlying descending aorta, which was resected en block with tumor-associated lung parenchyma. Aortic adventitia invasion by tumor led to local resection of adventitia (<1cm(2)) in nine patients (69%). Invasion deeper than adventitia was encountered in one case (8%), which was managed with aortic partial occlusion, resection of aortic wall and repair of the defect with Gore graft patch. In three patients (33%) the SVC wall was involved by the tumor 1-3cm in length and 2-4mm of the circumference. The defect was repaired with direct suturing. In five patients (56%) the area of SVC wall that was invaded was 3cmx2cm. The defect was repaired with Dacron patch. In 1 patient (11%) an arterial 14 graft was end-to-end interposed. All resections were radical (R0). Neither associated postoperative complications nor operative mortality was recorded. Five-year survival was 30.7% for the cases with aortic invasion and 11% for the ones with SVC involvement. CONCLUSIONS Radical surgical resection of lung tumors with localized aortic invasion can be considered after exclusion of N2 involvement.
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Affiliation(s)
- P Misthos
- Sismanogleio General Hospital, Thoracic Surgery Department, Athens, Greece.
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Ohta M, Hirabayasi H, Shiono H, Minami M, Maeda H, Takano H, Miyoshi S, Matsuda H. Surgical resection for lung cancer with infiltration of the thoracic aorta. J Thorac Cardiovasc Surg 2005; 129:804-8. [PMID: 15821646 DOI: 10.1016/j.jtcvs.2004.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the results of a combined resection of the thoracic aorta and primary lung cancer. METHODS Sixteen patients underwent thoracic aorta resection along with a left pneumonectomy (n = 6), left upper lobectomy (n = 9), or partial lung resection (n = 1), of whom 10 also received preoperative induction therapy. Cardiopulmonary bypass was used in 10 patients, and a passive shunt between the ascending aorta and the descending aorta was used in 4 patients. RESULTS Six postoperative major complications occurred in 5 patients, including postoperative bleeding (n = 3), intraoperative bleeding (n = 1), chylothorax (n = 1), and respiratory failure (n = 1). The postoperative morbidity rate was 31%, and the mortality rate was 12.5% (2/16). Furthermore, 4 patients died of systemic tumor relapse, and 1 patient died of intrapleural recurrence. Nine patients were alive after a median follow-up of 54 months (range, 12-199 months). The median survival time of patients with postoperative pathologic N0 disease was 31 months, whereas it was 10 months for those with pathologic N2 or N3 disease. Five-year survivals were 70% for patients with N0 disease and 16.7% for patients with N2 or N3 disease ( P = .0070). CONCLUSIONS Although pulmonary resection with the involved aorta might cause high surgical morbidity and mortality rates, encouraging long-term survivals were obtained in patients without mediastinal nodal involvement.
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Affiliation(s)
- Mitsunori Ohta
- Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan.
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Spaggiari L, D' Aiuto M, Veronesi G, Pelosi G, de Pas T, Catalano G, de Braud F. Extended Pneumonectomy With Partial Resection of the Left Atrium, Without Cardiopulmonary Bypass, for Lung Cancer. Ann Thorac Surg 2005; 79:234-40. [PMID: 15620949 DOI: 10.1016/j.athoracsur.2004.06.100] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Extended pneumonectomy with partial resection of the left atrium for lung cancer is not frequently performed; therefore, its results remain controversial. The present study analyzed a single center's experience with this extended surgery, highlighting the surgery's technical aspects, postoperative outcomes, and oncologic results. METHODS From November 1996 to December 2003, 15 patients underwent extended pneumonectomy with partial resection of the left atrium for lung cancer, without cardiopulmonary bypass. RESULTS Of the 15 patients (median age of 63 years, range 35 to 74 years), 11 were men (73%) and 4 were women. Six patients (40%) underwent preoperative invasive mediastinal staging. Nine patients (60%) underwent induction chemotherapy. Nine patients (60%) underwent right pneumonectomy. Pathologic analysis of the specimens identified 8 patients (53%) with N2 disease, 5 patients (33%) with N1 disease, and 2 patients with N0 disease. The T status was T4 in 10 patients, pT3 in 3 patients, and T0 in the remaining 2 patients. The were 10 squamous cell carcinomas (60%), 2 adenocarcinomas, 1 adenosquamous carcinoma, 1 mucoepidermoid carcinoma, and 1 atypical carcinoid tumor. The median intensive care unit and hospital stay were 1 day and 6.4 days, respectively. There were only two (15.3%) minor postoperative complications (atrial arrhythmias), which were successfully treated medically. There was no postoperative mortality. At completion of the study, 9 patients (60%) were still alive, with 8 showing no evidence of disease. The remaining 6 patients died because of systemic recurrences. The 3-year probability of survival was 39%. CONCLUSIONS Extended pneumonectomy with partial resection of the left atrium for advanced lung cancer is a feasible procedure, with low postoperative morbidity and mortality. In fact, it can lead to excellent local control of the disease, if not to a permanent cure in select patients.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery European Institute of Oncology, Milan, Italy.
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Mulligan CR, Cox E, Kuklo TR, Corcoran PC. Radical En Bloc Resection of a T4 Non-Small Cell Lung Cancer Invading the Thoracic Spine. Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.961s-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Ratto GB, Costa R, Vassallo G, Alloisio A, Maineri P, Bruzzi P. Twelve-year experience with left atrial resection in the treatment of non–small cell lung cancer. Ann Thorac Surg 2004; 78:234-7. [PMID: 15223435 DOI: 10.1016/j.athoracsur.2004.01.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND We retrospectively reviewed our 12-year experience in the surgical treatment of non-small cell lung cancer invading the left atrium. End points of the study were overall survival and factors potentially affecting survival. METHODS Nineteen consecutive patients with lung cancer invading the left atrium underwent surgery. Three patients with N2 disease underwent induction chemotherapy. Patients with either incomplete resections or pN2 disease received postoperative chemoradiotherapy. RESULTS Five-year survival was 14%, and the median survival time was 25 months. These figures refer to a very homogeneous group of patients with respect to the extent of atrial infiltration. Patients with N2 disease tended to have a worse outcome than patients with N0 or N1 disease (p = 0.06). The 3 patients with N2 disease who underwent induction chemotherapy were alive and disease-free at 30, 15, and 11 months from surgery. Survival was not affected by histology, type of surgery, or completeness of resection. Three patients with residual cancer in the atrial resection margin underwent postoperative chemoradiotherapy and are alive at 25, 17, and 15 months after surgery. CONCLUSIONS In spite of the poor survival rates we report, the present experience suggests that more-favorable results could be expected by the routine preoperative use of positron emission tomographic scan staging, a more-extensive assessment of atrial invasion, the application of induction chemotherapy in patients with N2 disease, and postoperative chemoradiotherapy in patients with tumors abutting the atrial resection margin.
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Affiliation(s)
- Giovanni B Ratto
- Department of Thoracic Surgery, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy.
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Doddoli C, Barlesi F, Chetaille B, Garbe L, Thomas P, Giudicelli R, Fuentes P. Large cell neuroendocrine carcinoma of the lung: an aggressive disease potentially treatable with surgery. Ann Thorac Surg 2004; 77:1168-72. [PMID: 15063228 DOI: 10.1016/j.athoracsur.2003.09.049] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessment of clinical and pathologic features of large cell neuroendocrine carcinoma to confirm its specificity in the setting of high grade neuroendocrine pulmonary tumors. METHODS From 1989 to 2001, 123 patients with a neuroendocrine carcinoma were surgically treated in a curative intent at a single institution. According to the 1999 World Health Organization classification, 20 patients were reviewed as having a large cell neuroendocrine carcinoma. Clinical data as well as detailed pathologic analysis and survival were collected. RESULTS There were 18 men and 2 women. The median age was 62 years. Four patients had a preoperative diagnosis of large cell neuroendocrine carcinoma. The resections consisted of 14 lobectomies and 6 pneumonectomies. There was no operative death. Complications occurred in 7 patients (35%). Four patients had a stage I of the disease, 4 had stage II, 9 had stage III, and 3 had stage IV. At follow-up (median, 46 months), 13 patients died from general recurrence and 7 patients were still alive. Median time to progression was 9 months (range, 1 to 54 months). The 5-year survival rate was 36% (median, 49 months) and it seemed to be negatively influenced by the disease stage (54% for stage I-II vs 25% for stage III-IV; p = 0.07), the presence of metastatic lymph node (45% for N0/N1 vs 17% for N2; p = 0.12), or vessel invasion (66 vs 25%; p = 0.18). CONCLUSIONS Large cell neuroendocrine carcinoma predominantly occurred in men. An accurate tissue diagnosis was rarely obtained preoperatively. Although overall survival after resection was substantial, large cell neuroendocrine carcinoma frequently showed pathologic features of occult metastatic disease, such as lymph node or vessel invasion, or both.
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Affiliation(s)
- Christophe Doddoli
- Department of Thoracic Surgery, Université de la Méditerranée (Aix-Marseille II), Faculty of Medicine, Sainte-Marguerite Hospital, France.
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