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Lobinger D, Hiebinger A, Eicher F, Groß G, Shalabi I, Reiche A, Bodner J. Rescue surgery in palliative indication as last therapeutic option for complicated advanced stage lung cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107253. [PMID: 37944369 DOI: 10.1016/j.ejso.2023.107253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/22/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the role of rescue surgery in complicated initially not operatively intended advanced stage lung cancer. MATERIALS AND METHODS Retrospective analysis of 30 patients with advanced lung cancer who underwent rescue surgery for control of life-threatening, non-conservatively manageable tumor related complications like post-obstructive pneumonia, super-infected tumor necrosis or active bleeding. Study parameters included tumor stage, histology, type of resection, and patients' characteristics as well as postoperative outcomes. RESULTS The study cohort consisted of 12 female and 18 male patients, among those 29 were diagnosed with Non-Small Cell Lung Cancer (NSCLC) and one with Small Cell Lung Cancer (SCLC). On initial tumor-diagnosis 20 patients had been classified as stage IV and 9 with stage III; 1 patient had not yet been completely staged at time of surgery for active tumor bleeding. In all patients, the indication for rescue surgery was not oncologic-therapeutic but to control non-conservatively manageable complications which either contradicted any tumor-specific systemic therapy or acutely threatened life. Types of resections included pneumonectomy, bi-lobectomy, lobectomy and segmentectomy. The mean overall survival was 13.3 (median 11.2) months, the 1-year-survival-probability of the cohort was 45,2%. The 30- and 90-day mortality was 13,3 and 30%, respectively. The reasons for early postoperative mortality were ARDS, multiorgan failure and bronchial-stump insufficiency. CONCLUSIONS Rescue surgery for tumor- or therapy-induced life-threatening complications in patients with advanced stage lung cancer is associated with high morbidity and mortality. However, if all other treatment options have failed it nevertheless may be indicated as the last therapeutic chance and if surgery succeeds in controlling the acute event it may also set the condition for subsequent tumor-specific therapies. Future research should focus on elaborating effective criteria regarding patient selection and timing of surgery in order to restrict these high-risk-operations to only those patients, who most likely will benefit.
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Affiliation(s)
- Dominik Lobinger
- Department of Thoracic Surgery, Munich Clinic Bogenhausen (Academic Teaching Hospital of TUM), Munich, Germany.
| | - Andreas Hiebinger
- Department of Thoracic Surgery, Munich Clinic Bogenhausen (Academic Teaching Hospital of TUM), Munich, Germany
| | - Florian Eicher
- Department of Thoracic Surgery, Munich Clinic Bogenhausen (Academic Teaching Hospital of TUM), Munich, Germany
| | - Gudrun Groß
- Department of Thoracic Surgery, Munich Clinic Bogenhausen (Academic Teaching Hospital of TUM), Munich, Germany
| | - Iyad Shalabi
- Department of Thoracic Surgery, Munich Clinic Bogenhausen (Academic Teaching Hospital of TUM), Munich, Germany
| | - Alicia Reiche
- Department of Thoracic Surgery, Munich Clinic Bogenhausen (Academic Teaching Hospital of TUM), Munich, Germany
| | - Johannes Bodner
- Department of Thoracic Surgery, Munich Clinic Bogenhausen (Academic Teaching Hospital of TUM), Munich, Germany
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2
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Rosenstein AL, Potter AL, Senthil P, Raman V, Kumar A, Muniappan A, Berry MF, Yang CFJ. The Role of Salvage Resection After Definitive Radiation Therapy for Non-small Cell Lung Cancer. Ann Thorac Surg 2023; 116:997-1003. [PMID: 37544397 DOI: 10.1016/j.athoracsur.2023.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND This study evaluated outcomes of patients who undergo extended delay to resection after definitive radiation therapy for non-small cell lung cancer (NSCLC). METHODS Perioperative outcomes and 5-year overall survival of patients with NSCLC who underwent definitive radiation therapy, followed by resection, from 2004 to 2020 in the National Cancer Database were evaluated. Patients who underwent resection >180 days after the initiation of radiation therapy (including any external beam therapy at a total dose of >60 Gy) were included in the analysis. Subgroup analyses were conducted by operation type and pathologic nodal status. RESULTS From 2004 to 2020, 293 patients had an extended delay to resection after definitive radiation therapy. The clinical stage distribution was stage I to II in 53 patients (18.1%), stage IIIA in 111 (37.9%), stage IIIB in 106 (36.2%), stage IIIC in 13 (4.4%), and stage IV in 10 (3.4%). Median dose of radiation therapy received was 64.8 Gy (interquartile range, 60.0-66.6 Gy). Median days from radiation therapy to resection were 221.0 (interquartile range, 193.0-287.0) days. Lobectomy (64.5%) was the most common operation, followed by pneumonectomy (17.1%) and wedge resection (7.5%). For wedge resection, lobectomy, and pneumonectomy, the 30-day readmission rate was 4.8%, 4.8%, and 8.3%, the 30-day mortality rate was 0%, 3.4%, and 6.4%, and the 90-day mortality rate was 0%, 6.2%, and 12.8%, respectively. Overall survival at 5 years for patients with pN0, pN1, and pN2 disease was 38.6% (95% CI, 30.0-47.2), 43.3% (95% CI, 16.3-67.9), and 24.0% (95% CI, 9.8-41.7), respectively. CONCLUSIONS In this national analysis, extended delay to resection after definitive radiation therapy was associated with acceptable perioperative outcomes among a highly selected patient cohort.
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Affiliation(s)
- Allison L Rosenstein
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Priyanka Senthil
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Arvind Kumar
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ashok Muniappan
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Wang YH, Tsai SCS, Lin FCF. Reduction of Blood Loss by Means of the Cavitron Ultrasonic Surgical Aspirator for Thoracoscopic Salvage Anatomic Lung Resections. Cancers (Basel) 2023; 15:4069. [PMID: 37627096 PMCID: PMC10452171 DOI: 10.3390/cancers15164069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
In centrally located lung tumors, salvage pulmonary resections pose challenges due to adhesions between the pulmonary parenchyma, chest wall, and hilum. This study aimed to investigate the surgical outcomes associated with Cavitron Ultrasonic Surgical Aspirator (CUSA) usage in thoracoscopic salvage pulmonary resections. Patients with centrally located advanced-stage lung tumors who underwent salvage anatomic resections following systemic or radiotherapy were included. They were categorized into CUSA and non-CUSA groups, and perioperative parameters and surgical outcomes were analyzed. Results: The study included 7 patients in the CUSA group and 15 in the non-CUSA group. Despite a longer median surgical time in the CUSA group (3.8 h vs. 6.0 h, p = 0.021), there was a significant reduction in blood loss (100 mL vs. 250 mL, p = 0.014). Multivariate analyses revealed that the use of CUSA and radiotherapy had opposing effects on blood loss (β: -296.7, 95% CI: -24.8 to -568.6, p = 0.034 and β: 282.9, 95% CI: 19.7 to 546.3, p = 0.037, respectively). In conclusion, while using CUSA in the salvage anatomic resection of centrally located lung cancer may result in a longer surgical time, it is crucial in minimizing blood loss during the procedure.
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Affiliation(s)
- Yu-Hsiang Wang
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Stella Chin-Shaw Tsai
- Superintendent Office, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Frank Cheau-Feng Lin
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
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Choi J, Tocco B, Smith A, Ahmad S, Josephides E, Bille A. Multimodality Treatment and Salvage Surgery for the Treatment of Lung Cancer. Cancers (Basel) 2023; 15:3586. [PMID: 37509246 PMCID: PMC10377332 DOI: 10.3390/cancers15143586] [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: 03/30/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 07/30/2023] Open
Abstract
Lung cancer remains the leading cause of cancer deaths in the United Kingdom. For locally advanced disease, multimodality treatment is recommended, which includes a combination of chemotherapy, radiotherapy, surgery and, more recently immunotherapy. Options depend on the resectability of the cancer and there has been debate about the optimal treatment strategy: surgery may be planned to follow chemoradiotherapy (CRT), be offered for residual disease after CRT, or given as salvage therapy for patients treated with CRT who have later relapse of their disease. We conducted a retrospective analysis of all patients who underwent CRT and surgical resection under a single surgical team and performed a descriptive study after dividing the patients into these three groups. For the planned trimodality group, 30-day mortality this was 7% (n = 1) and 1-year survival was 78.6%; the residual disease group had a 30-day mortality rate of 0% and 1-year survival of 81.3%; for the salvage group, the figures were 0% and 62.5%, respectively. The median overall survival of the study population was 35.8 months. Median overall survival in the trimodality group was 35.4 months (20.1-51.7 interquartile range IQR), for the residual group was 34.2 months (18.5-61.0 IQR). and for the salvage group was 35.8 months (32.4-52.7 IQR).).
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Affiliation(s)
- Jeesoo Choi
- Thoracic Surgery, Guy's Hospital, London SE1 9RT, UK
| | - Boris Tocco
- Department of Clinical Oncology, Guy's Hospital, London SE1 9RT, UK
| | | | - Shahreen Ahmad
- Department of Clinical Oncology, Guy's Hospital, London SE1 9RT, UK
| | - Eleni Josephides
- Department of Clinical Oncology, Guy's Hospital, London SE1 9RT, UK
| | - Andrea Bille
- Thoracic Surgery, Guy's Hospital, London SE1 9RT, UK
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Motas N, Manolache V, Scarci M, Nimigean V, Nimigean VR, Simion L, Mizea MC, Trifanescu OG, Galateanu B, Gherghe M, Capsa CM, Gonzalez-Rivas D, Davidescu MD. Salvage Surgery for Small-Cell Lung Cancer-A Literature Review. Cancers (Basel) 2023; 15:cancers15082241. [PMID: 37190169 DOI: 10.3390/cancers15082241] [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: 03/12/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Salvation surgery for small-cell lung cancer (SCLC) is exceptionally performed, and only a few cases are published. (2) Methods: There are 6 publications that present 17 cases of salvation surgery for SCLC-the salvation surgery was performed in the context of modern clearly established protocols for SCLC and after including SCLC in the TNM (tumor, node, metastasis) staging in 2010. (3) Results: After a median follow-up of 29 months, the estimated overall survival (OS) was 86 months. The median estimated 2-year survival was 92%, and the median estimated 5-year survival was 66%. (4) Conclusion: Salvage surgery for SCLC is a relatively new and extremely uncommon concept and represents an alternative to second-line chemotherapy. It is valuable because it may offer a reasonable treatment for selected patients, good local control, and a favorable survival outcome.
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Affiliation(s)
- Natalia Motas
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
- Department of Thoracic Surgery, Oncology Hospital Memorial, 013812 Bucharest, Romania
| | - Veronica Manolache
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, Oncology Hospital Memorial, 013812 Bucharest, Romania
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College NHS Healthcare, Hammersmith Hospital Du Cane Road, London W12 0HS, UK
| | - Victor Nimigean
- Department of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest, 022328 Bucharest, Romania
| | - Vanda Roxana Nimigean
- Department of Oral Rehabilitation, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest, 022328 Bucharest, Romania
| | - Laurentiu Simion
- Discipline of General and Oncological Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of General and Oncologic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
| | - Madalina Cristiana Mizea
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
| | - Oana Gabriela Trifanescu
- Discipline of Oncology, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Radiotherapy, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
| | - Bianca Galateanu
- Department of Biochemistry and Molecular Biology, University of Bucharest, 022328 Bucharest, Romania
| | - Mirela Gherghe
- Discipline of Nuclear Medicine, "Prof. Dr. Al. Trestioreanu" Institute of Oncology and University Emergency Military Hospital "Dr. Carol Davila", 022328 Bucharest, Romania
| | - Cristina Mirela Capsa
- Department of Radiology "Prof. Dr. Alexandru Trestioreanu", 022328 Bucharest, Romania
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Oncology Hospital Memorial, 013812 Bucharest, Romania
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15008 Coruña, Spain
| | - Mihnea Dan Davidescu
- Discipline of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, 022328 Bucharest, Romania
- Department of Thoracic Surgery, "Prof. Dr. Al. Trestioreanu" Institute of Oncology, 022328 Bucharest, Romania
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Etienne H, Kalt F, Park S, Opitz I. The oncologic efficacy of extended resections for lung cancer. J Surg Oncol 2023; 127:296-307. [PMID: 36630100 DOI: 10.1002/jso.27183] [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: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
Extended lung resections for T3-T4 non-small-cell lung cancer remain challenging. Multimodal management is mandatory in multidisciplinary tumor boards, and here the determination of resectability is key. Long-term oncologic efficacy depends mostly on complete resection (R0) and the extent of N2 disease. The development of novel innovative treatments (targeted therapy and immune checkpoint inhibitors) sets interesting perspectives to reinforce current therapeutic options in the induction and adjuvant setting.
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Affiliation(s)
- Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Kalt
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Samina Park
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Kaba E, Cosgun T, Yardimci H, Toker A. Prognostic Factors in Patients with Clinic Locally Advanced T4 Lung Cancer: Surgical Considerations. Thorac Cardiovasc Surg 2022; 71:231-236. [PMID: 36535651 DOI: 10.1055/s-0042-1759722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background Inclusion of surgery in the treatment of T4 lung cancer has been a debate for the last two decades. The aim of this study is to investigate the potential prognostic factors which could affect the outcome.
Methods Fifty-seven clinical T4 non-small cell lung carcinoma (NSCLC) patients out of 716 lung resections, who were operated at a single institution in 7 years period, were included in this study. Patients are grouped into three groups as patients with neoadjuvant treatment group (group 1 n: 16), salvage surgery group (surgery after 3 months of definitive chemotherapy and radiotherapy) (group 2 n: 14), and straightforward surgery group (group 3 n: 27) with adjuvant treatment. Groups were analyzed and compared in terms of postoperative complications, 30 days of mortality, disease free survival, and overall survival.
Results Mean overall survival (OS) was 48.43 ± 4.4 months and mean disease-free survival (DFS) 40.55 ± 4.46 months for all patients. Thirty days mortality was 5.2% and complication rates were 63.1%. Two years OS was 61.4 ± 6.4%, DFS was 58.1 ± 7.8%. Group 1, Group 2, and Group 3 patients had mean 39.14 ± 5.6, 44.7 ± 7.1, and 62.9 ± 4.8 months for OS (p: 0.09), and 29.6 ± 7.2, 38.4 ± 9.1, and 46.9 ± 6 months for DFS (p: 0.27). Patients who received blood transfusion showed significantly worse outcomes (p: 0.001 for DFS and p: 0.004 for OS).
Conclusion According to our outcomes, surgery should be included in the treatment of clinical T4 lung cancer when physiologically and oncologically possible with careful patient selection. This study demonstrates that patients receiving straightforward surgery have longer survival, in spite of higher perioperative mortality rate. Risks and benefits should be considered carefully.
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Affiliation(s)
- Erkan Kaba
- Department of Thoracic Surgery, TC Demiroğlu Bilim Üniversitesi Ringgold Standard Institution, Istanbul, İstanbul, Turkey
| | - Tugba Cosgun
- Department of Thoracic Surgery, Istinye University Ringgold Standard Institution, Istanbul, Turkey
| | - Halit Yardimci
- Department of Thoracic Surgery, İstanbul Dr Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi Ringgold Standard Institution, Istanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, West Virginia University Ringgold Standard Institution, Morgantown, West Virginia, United States
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Hino H, Utsumi T, Maru N, Matsui H, Taniguchi Y, Saito T, Tsuta K, Murakawa T. Results of emergency salvage lung resection after chemo- and/or radiotherapy among patients with lung cancer. Interact Cardiovasc Thorac Surg 2022; 35:ivac043. [PMID: 35253874 PMCID: PMC9714598 DOI: 10.1093/icvts/ivac043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES This study aimed to elucidate the outcomes of emergency salvage surgery following life-threatening events (serious haemorrhage and/or infections) among patients with lung cancer who had undergone chemo- and/or radiotherapy. MATERIALS AND METHODS We analysed the data of patient from 2015 to 2020, retrospectively. The clinical characteristics, including preoperative treatment, perioperative outcomes and survival time, were analysed. RESULTS Of the 862 patients who underwent primary lung cancer surgeries, 10 (1.2%) underwent emergency surgeries. The preoperative clinical characteristics were: median age, 63.7 years [interquartile range (IQR) 55-70.5]; sex (male/female), 9/1; clinical staging before initial treatment (I/II/III/IV), 1/1/3/5; initial treatment (chemoradiotherapy/chemotherapy/proton beam therapy), 5/4/1; and indications for emergency surgery (lung abscess/lung abscess with haemoptysis/haemoptysis/empyema), 5/3/1/1. The selected procedures and results were as follows: lobectomy/bilobectomy/pneumonectomy, 8/1/1 (all open thoracotomies); median operation time, 191.0 min (IQR 151-279); median blood loss, 1071.5 ml (IQR 540-1691.5); postoperative severe complications, 3 (30%); hospital mortality, none; median postoperative hospital stay, 37 days (12-125); control of infection and/or haemoptysis, all the cases; final outcome (alive/dead), 3/7 (all the cancer deaths); median postoperative survival, 9.4 months (IQR 4.3-20.4); and median survival from initial treatment, 19.4 months (IQR 8.0-66.9). CONCLUSIONS Emergency salvage lung resection is a technically challenging procedure; however, the results were feasible and acceptable when the surgical indication, procedure and optimal timing were considered carefully by a multidisciplinary team. Although the aim was palliation, some patients who received additional chemotherapy afterwards and, thus, had additional survival time.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Takahiro Utsumi
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Natsumi Maru
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Hiroshi Matsui
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Yohei Taniguchi
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Koji Tsuta
- Department of Pathology, Kansai Medical University, Osaka, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
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Patient Selection for Local Aggressive Treatment in Oligometastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13246374. [PMID: 34944994 PMCID: PMC8699700 DOI: 10.3390/cancers13246374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Since the first introduction of the oligometastatic state with a low burden of metastases in non-small cell lung cancer, accumulating evidence from retrospective and prospective studies has shown that a local aggressive, multimodality treatment may significantly improve the prognosis in these patients. Local aggressive treatment includes a systemic therapy of micrometastatic disease, as well as a radical resection of the primary tumor and surgical resection and/or radiation therapy of distant metastases. However, patient selection and treatment allocation remain a central challenge in oligometastatic disease. In this review, we aimed to address the current evidence on criteria for patient selection for local aggressive treatment in non-small cell lung cancer. Abstract One-fourth of all patients with metastatic non-small cell lung cancer presents with a limited number of metastases and relatively low systemic tumor burden. This oligometastatic state with limited systemic tumor burden may be associated with remarkably improved overall and progression-free survival if both primary tumor and metastases are treated radically combined with systemic therapy. This local aggressive therapy (LAT) requires a multidisciplinary approach including medical oncologists, radiation therapists, and thoracic surgeons. A surgical resection of the often advanced primary tumor should be part of the radical treatment whenever feasible. However, patient selection, timing, and a correct treatment allocation for LAT appear to be essential. In this review, we aimed to summarize and discuss the current evidence on patient selection criteria such as characteristics of the primary tumor and metastases, response to neoadjuvant or first-line treatment, molecular characteristics, mediastinal lymph node involvement, and other factors for LAT in oligometastatic NSCLC.
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Hino H, Nakahama K, Ogata M, Kibata K, Miyasaka C, Utsumi T, Maru N, Matsui H, Taniguchi Y, Saito T, Tsuta K, Murakawa T. Emergent salvage surgery for massive hemoptysis after proton beam therapy for lung cancer: a case report. Surg Case Rep 2021; 7:98. [PMID: 33877476 PMCID: PMC8058119 DOI: 10.1186/s40792-021-01177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background Salvage surgery is an effective therapeutic option for patients experiencing relapses after chemoradiotherapy for advanced-stage lung cancer or after high-dose radiotherapy for early-stage lung cancer. We report a case involving an emergent salvage surgery for a patient with massive hemoptysis who developed lung cancer recurrence after undergoing proton beam therapy 7 years prior to presentation. Case presentation A 70-year-old male patient was emergently admitted due to massive hemoptysis. He had undergone proton beam therapy for a stage I adenocarcinoma of the left upper lobe 7 years ago, and was receiving chemotherapy for local recurrence. We performed an emergent salvage pulmonary resection to achieve hemostasis. During the operation, we confirmed the presence of a left broncho-pulmonary arterial fistula, which was considered as the origin of the massive hemoptysis. We repaired the fistula between the pulmonary artery and left upper bronchus without incident; an orifice of the fistula at the left pulmonary artery was sutured using a non-absorbable monofilament, and the central portion of the orifice of the fistula at the left upper bronchus was closed with a mechanical stapling device. The postoperative diagnosis was of an adenocarcinoma—ypT3(pm1) N0M1a (dissemination)-IVA, ef1b. The patient has survived for over a year with the cancer in almost complete remission following the administration of an epidermal growth factor receptor tyrosine kinase inhibitor. Conclusions Emergent salvage surgery demands high skill levels with optimal timing and correct patient selection. Our case suggested that the procedure played an important role in controlling serious bleeding and/or infectious conditions. Consequently, he could receive chemotherapy again and survive for over a year. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-021-01177-9.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan.
| | - Kahori Nakahama
- First Department of Internal Medicine, Division of Thoracic Oncology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Makoto Ogata
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Kayoko Kibata
- First Department of Internal Medicine, Division of Thoracic Oncology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Takahiro Utsumi
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Natsumi Maru
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Hiroshi Matsui
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Yohei Taniguchi
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Koji Tsuta
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
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Joosten PJM, Dickhoff C, van der Noort V, Klomp HM, van Diessen JNA, Dahele M, Bahce I, Veenhof AAFA, Smit EF, Hartemink KJ. Is pneumonectomy justifiable for patients with a locoregional recurrence or persistent disease after curative intent chemoradiotherapy for locally advanced non-small cell lung cancer? Lung Cancer 2020; 150:209-215. [PMID: 33220611 DOI: 10.1016/j.lungcan.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Locoregional recurrence and persistent/progressive disease after curative-intent definitive chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) is challenging to manage, as salvage options are limited. Selected patients might be candidates for resection. This study evaluated the outcomes of patients after salvage surgery for locoregional recurrence, focusing specifically on morbidity and mortality after salvage pneumonectomy. MATERIALS AND METHODS This retrospective study included patients from 2 tertiary referral hospitals who underwent salvage pulmonary resection for locoregional recurrence or disease persistence/progression >12 weeks after completion of curative intent high dose (>60 Gy) CRT. Disease-free (DFS) and overall survival (OS) were estimated and the influence of patient and treatment characteristics on these endpoints was assessed. RESULTS A total of 30 patients treated between 2015-2017 were identified with a median age of 60 years (range 42-72 years), 67 % were male. Median follow-up was 47 months (95 % CI 46-NR). Pneumonectomy was performed in 13/30 (43 %) patients and lobectomy in 17/30 (57 %). Median DFS and OS after pneumonectomy/lobectomy were 14/6 and NR/17 months, respectively. 30 and 90-day mortality for pneumonectomy/lobectomy were 0/12 % and 0/24 % respectively. More favorable survival was seen after pathologically radical resection, i.e. R0, and when surgery was performed more than 12 months after completion of CRT. CONCLUSION Salvage surgery, including pneumonectomy is associated with acceptable outcomes in selected patients with recurrent or persistent/progressive NSCLC after curative-intent high dose CRT. Patients should be assessed for the probability of an R0 resection, and patients with a locoregional recurrence more than 12 months after treatment with CRT may benefit most from salvage surgery.
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Affiliation(s)
- Pieter J M Joosten
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Cancer Center Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Cancer Center Amsterdam, the Netherlands
| | - Vincent van der Noort
- Department of Biometrics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Houke M Klomp
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Judi N A van Diessen
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Alexander A F A Veenhof
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
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Salvage Surgery After Chemotherapy or Chemoradiotherapy for Initially Unresectable Lung Carcinoma. Ann Thorac Surg 2019; 108:1664-1670. [PMID: 31445048 DOI: 10.1016/j.athoracsur.2019.06.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/30/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Salvage surgery is used for resection of locoregionally recurrent or regrowing lesions after treatment for unresectable non-small cell lung cancer. It is also used to resect lesions that have regressed after treatment and that had not initially been indicated for resection. Relationships between salvage surgery, safety, and prognosis, however, have remained unclear. METHODS Between 2006 and 2017, 29 patients received salvage resection (median age, 60 years; 25 men and 4 women). Safety and prognosis were analyzed. RESULTS Tumor grade at the time of initial treatment was stage III or IV in 23 and 6 patients, respectively. Twenty-two patients received chemoradiotherapy (radiation, 40-66 Gy) and 7 received chemotherapy. Time from initial treatment to surgery ranged from 2 to 60 months. Segmentectomy, lobectomy, bilobectomy and pneumonectomy were performed in 1, 25, 2, and 1 patients, respectively. Combined resections were needed in 17 patients; this included 10 bronchoplasties, 9 pulmonary arterioplasties, 4 chest wall resections, and 1 great vessel resection. There was no 30-day postoperative mortality. Grade 3 or higher-grade postoperative complications (mostly cardiopulmonary) were observed in 11 patients. Five-year overall survival after initial treatment was 61%; after surgery it was 51%. Five-year relapse-free survival after surgery was 49%. On recurrent-free survival patients with clinical stage III at the initial treatment, pathologic stage 0-II, or a good response to initial treatment showed a favorable prognosis. CONCLUSIONS Although cardiopulmonary complications can accompany salvage surgery, the procedure is generally safe. Survival outcome is encouraging, especially in cases with good response to initial treatment.
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Kanayama M, Ichiki Y, Mori M, Matsumiya H, Nabe Y, Taira A, Shinohara S, Kuwata T, Takenaka M, Hirai A, Imanishi N, Yoneda K, Ikushima E, Yasutsune T, Nishimura Y, Tanaka F. Salvage surgery combined with descending aorta resection for lung cancer. Surg Case Rep 2019; 5:114. [PMID: 31332588 PMCID: PMC6646477 DOI: 10.1186/s40792-019-0675-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Recent retrospective studies have shown that salvage surgery can improve survival with acceptable adverse events, and this procedure has been adapted for lung cancer. However, there are no reports demonstrating the efficacy of salvage surgery combined with aortic resection. Case presentation A 73-year-old man had received definitive concurrent chemoradiotherapy (carboplatin/paclitaxel, 70 Gy) for lung cancer originated from the left upper lobe and infiltrating the thoracic aorta (cT4N1M0 stage IIIA). Although the tumor has shrunk significantly (ycT4N0M0 stage IIIA), radiation pneumonitis occurred. Due to the steroid therapy, radiation pneumonitis was relieved; however, re-enlargement of the primary tumor was observed during steroid tapering. Nonetheless, the lymphatic and distant metastases were controlled. Moreover, aortic invasion was localized to the periphery of the third branch, and the tumor was considered to be resectable. Intraoperatively, we observed macroscopic evidence of aortic invasion in the periphery of the third branch; thus, left upper lobectomy combined with descending aorta resection was performed under partial extracorporeal circulation. The patient is currently active without any recurrence 21 months post-surgery. Conclusions No clear consensus exists regarding salvage surgery combined with aortic resection for primary lung cancer. However, we believe that this surgery may improve the survival of carefully selected patients.
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Affiliation(s)
- Masatoshi Kanayama
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Yoshinobu Ichiki
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masataka Mori
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Hiroki Matsumiya
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yusuke Nabe
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Akihiro Taira
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Shinji Shinohara
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Taiji Kuwata
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masaru Takenaka
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Ayako Hirai
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Naoko Imanishi
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kazue Yoneda
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Eigo Ikushima
- Cardiovascular Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Toru Yasutsune
- Cardiovascular Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yosuke Nishimura
- Cardiovascular Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Romero-Vielva L, Viteri S, Moya-Horno I, Toscas JI, Maestre-Alcácer JA, Ramón Y Cajal S, Rosell R. Salvage surgery after definitive chemo-radiotherapy for patients with Non-Small Cell Lung Cancer. Lung Cancer 2019; 133:117-122. [PMID: 31200817 DOI: 10.1016/j.lungcan.2019.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/26/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Despite all treatment advances, lung cancer is still the main cause of death worldwide. Treatment for resectable stage IIIA remains controversial including definitive chemoradiotherapy and induction treatment followed by surgery. After definitive chemoradiation up to 35% of patients will relapse locally. Experience with salvage resection after definitive chemoradiotherapy in lung cancer is limited. We present our experience in 27 patients who underwent surgical resection after definitive treatment. PATIENTS AND METHODS Between January 2007 and December 2016, 27 patients were evaluated in our department for surgical resection after receiving definitive chemoradiation treatment in different institutions. We conducted a retrospective study gathering the following data: age, gender, clinical and pathologic stage, histology, chemotherapy treatment regimen, radiotherapy dosage, surgical procedure and complications. Time between surgical resection and last follow-up was used to calculate Overall Survival (OS). Disease-Free Survival (DFS) was calculated from surgical resection to diagnosis of relapse. RESULTS Most of the patients were men with a median age of 56.09 years. Median follow-up time was 46.94 months. All patients received platinum-based chemotherapy regimen and high-dose radiotherapy, except for one patient who received 45 Gy. Lobectomy and bilobectomy was performed in 7 patients each, and pneumonectomy in 13. Complications appeared in 5 patients. Bronchopleural fistula appeared in two patients, and only one death in the early postoperative period. The analysis showed an OS of 75.56 months, with 1-year, 3-year and 5-year survival of 74.1%, 57.8% and 53.3% respectively. CONCLUSION Salvage surgery in selected patients is technically feasible, with low morbidity and mortality rates and good long-term outcomes.
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Affiliation(s)
- Laura Romero-Vielva
- Thoracic Surgery Department, University Hospital General de Catalunya, C/ Pedro i Pons, 1., 08195, Sant Cugat del Vallès, Spain.
| | - Santiago Viteri
- Medical Oncology Department, Rosell Oncology Institute (IOR), Dexeus University Hospital, Quironsalud Group, C/ Sabino Arana 5-19, 08028, Barcelona, Spain
| | - Irene Moya-Horno
- Medical Oncology Department Instituto Oncológico Dr Rosell (IOR), University Hospital General de Catalunya, C/ Pedro i Pons, 1., 08195, Sant Cugat del Vallès, Spain
| | - José Ignacio Toscas
- Radio-oncology Department, Institut Oncològic Teknon (IOT), Carrer de Vilana, 12, 08022, Barcelona, Spain
| | - José Antonio Maestre-Alcácer
- Thoracic Surgery Department, University Hospital General de Catalunya, C/ Pedro i Pons, 1., 08195, Sant Cugat del Vallès, Spain
| | - Santiago Ramón Y Cajal
- Pathology Department, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Rafael Rosell
- Medical Oncology Department, Rosell Oncology Institute (IOR), Dexeus University Hospital, Quironsalud Group, C/ Sabino Arana 5-19, 08028, Barcelona, Spain
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