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Hsu J, Chou PR, Huang JW, Liu YW, Chiang HH, Lee JY, Li HP, Chang PC, Chou SH. Is extended resection for locally advanced thoracic cancer with cardiopulmonary bypass justified? BMC Surg 2024; 24:334. [PMID: 39462357 PMCID: PMC11515205 DOI: 10.1186/s12893-024-02632-8] [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: 06/04/2024] [Accepted: 10/14/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND Resection of intrathoracic tumor with cardiopulmonary bypass (CPB) remains a relatively under-reported intervention in literature, and its role in managing locally advanced mediastinal and lung cancers is a topic of ongoing debate. Our aim was to review our experience and assess the role of CPB for treating locally advanced mediastinal and lung cancers. METHODS Between 2015 and 2020, this study initially included 10 patients with primary locally advanced thoracic malignancies with apparent adjacent cardiovascular invasion demonstrated by thoracic imaging scans. Operation was performed based on a multidisciplinary tumor board consensus. Eventually, 8 patients (3 primary lung cancers and 5 mediastinal cancers) received either salvage or elective resection with CPB; two completed surgery without requiring CPB. RESULTS Regarding the extent of adjacent structure involvement, 4 patients presented with involvement of the superior vena cava (SVC), 1 involved the right atrium (RA), 2 involved the SVC and RA, and 1 involved the SVC, the origin of main pulmonary artery, and the ascending aorta. Thirty-day mortality occurred in two of three patients receiving salvage surgery due to respiratory insufficiency. With the long-term follow-up, one patient died of recurrence 25 months postoperatively, one survived with recurrence 30 months postoperatively, and four were alive without recurrence for 35, 36, 49, and 107 months after operations. CONCLUSION In certain patients, particularly for elective surgical candidates rather than salvage resection, CPB allows for extended resection of locally advanced thoracic cancers with acceptable perioperative safety and survival.
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Affiliation(s)
- Joffrey Hsu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Ping-Ruey Chou
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Jiann-Woei Huang
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.
| | - Hung-Hsing Chiang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Jui-Ying Lee
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Hsien-Pin Li
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
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Inci I. Extended Pulmonary Resection for T4 Non-Small Cell Lung Cancer. PRAXIS 2023; 112:103-110. [PMID: 36722106 DOI: 10.1024/1661-8157/a003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
T4 non-small cell lung cancer is a locally advanced disease with poor prognosis. The operation can be challenging even for an experienced surgeon. N2 disease has been shown repeatedly as a risk factor for poor outcome, and these patients should not be candidates for surgical treatment. Surgery for locally advanced T4 tumors without mediastinal lymph node involvement (T4N0 and T4N1) has been demonstrated to result in good outcomes in carefully selected patients. Patients with T4N0-1M0 should be rejected for surgery only after consulting an expert surgical center. As with other stages, the decision for resectability and surgery should be made by a multidisciplinary team.
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Affiliation(s)
- Ilhan Inci
- Klinik Hirslanden, Chirurgisches Zentrum Zürich, Thoracic Surgery, Zurich, Switzerland
- School of Medicine, University of Zurich, Zurich, Switzerland
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Dell'Amore A, Campisi A, De Franceschi E, Bertolaccini L, Gabryel P, Chen C, Ciarrocchi AP, Russo MD, Cannone G, Fang W, Piwkowski C, Spaggiari L, Rea F. Surgical results of non-small cell lung cancer involving the heart and great vessels. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1929-1936. [PMID: 35246347 DOI: 10.1016/j.ejso.2022.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The surgical treatment of advanced non-small-cell-lung-cancer (NSCLC) invading mediastinal organs and great vessels is still controversial. The aim of this multicentre study is to analyse oncological outcomes, surgical outcomes and prognostic factors of patients with NSCLC involving heart and great vessels. METHODS 362 patients treated surgically for locally advanced T4-NCSLC between 1990 and 2020 were retrospectively reviewed. Patients were divided into five subgroups: pulmonary artery(n = 129), left atrium(n = 82), superior vena cava(n = 80), aorta(n = 43), and multiple vascular structures(n = 28). Resection was complete in 327(90%) patients. RESULTS Overall 90-day mortality was 8.8%, influenced by poly-transfusions, pneumonectomy, bronchopleural fistula and previous cardiovascular disease (4.5HR.p = 0.03, 3.7HR p = 0.01, 14.0HR.p < 0.001 and 3.0HR p < 0.01). One-, 3- and 5-year survival rates were 75%, 43%, 33%, respectively and there were significant differences among the five groups(p < 0.001). Survival was significantly affected by induction radiotherapy, nodal status, pTNM-stage and radicality (3.8HR p = 0.03, 2.6HR p = 0.001, 1.6HR p < 0.05 and 1.6HR p < 0.05). CONCLUSIONS Surgery provided acceptable results in selected patients with T4-NSCLC with major vascular infiltration in expert centres. Nodal-status and radicality influenced the overall-survival and disease-free survival. Neoadjuvant chemotherapy appears to have a positive effect on long-term results, particularly in N2-patients.
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Affiliation(s)
- Andrea Dell'Amore
- Department of Cardio-Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, University of Padova, Italy
| | - Alessio Campisi
- Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University, Shanghai, China.
| | - Elisa De Franceschi
- Department of Cardio-Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, University of Padova, Italy
| | - Luca Bertolaccini
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Science, Poznan, Poland
| | - Chunji Chen
- Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University, Shanghai, China
| | | | - Michele Dario Russo
- Department of Cardio-Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, University of Padova, Italy
| | - Giorgio Cannone
- Department of Cardio-Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, University of Padova, Italy
| | - Wentao Fang
- Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University, Shanghai, China
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Science, Poznan, Poland
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Federico Rea
- Department of Cardio-Thoracic, Vascular Sciences and Public Health, Thoracic Surgery Unit, University of Padova, Italy
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HU C, ZHAO C, LAI P, WANG X, LIANG Z. The effect of refined nursing applied in the nursing room of thoracoscopic lung cancer radical operation in Southwestern China. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.46321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Ping LAI
- People's Hospital of Deyang City, China
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Zhong Y, Wei Q, Lu Y, Tang X, Wang Z, Chen L. Efficacy and safety of anlotinib in patients with advanced non-small cell lung cancer. J Thorac Dis 2020; 12:6016-6022. [PMID: 33209434 PMCID: PMC7656407 DOI: 10.21037/jtd-20-2855] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and its incidence seriously affects human health. The purpose of this study was to evaluate the efficacy and safety of anlotinib in patients with advanced NSCLC. Methods A retrospective study was conducted on 150 patients with advanced NSCLC who were treated with anlotinib and discontinued treatment after disease progression or intolerance due to adverse events. Progression-free survival (PFS) of advanced NSCLC patients served as an endpoint. Kaplan-Meier survival curves were applied to evaluate the short-term efficacy of anlotinib treatment in advanced NSCLC patients. Results The median PFS of the whole 150-patient cohort was 5.0 months in (95% CI: 4.00–5.95), 5.0 months (95% CI: 3.0–6.00) in 90 patients with adenocarcinoma, and 4.5 months (95% CI: 4.00–7.00) in 60 patients with squamous cell carcinoma (P=0.676). The PFS was 6.5 months (95% CI: 4.00–8.80) and 4.5 months (95% CI: 4.00–5.60) in the first-/second-line and ≥ third-line patients, respectively (P=0.315). Following the Eastern Cooperative Oncology Group performance status (ECOG PS) score, the median PFS of 95 patients with a PS score 0–1 was 5.5 months (95% CI: 4.50–6.50), and the median PFS of 55 patients with a PS score ntswas 4.0 months (95% CI: 3.00–5.00) (P=0.221). For the 49 patients in the combination group the median PFS was 7.0 months (95% CI: 4.00–9.00), while that of the 101 patients in the anlotinib-alone group was 4.0 months in (95% CI: 2.80–5.50) (P=0.010). In a separate analysis of the combination group, the median PFS of anlotinib combined with chemotherapy, epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), and immunotherapy was 5.5 months (95% CI: 4.00–9.00), 12.0 months (95% CI: 6.00–12.00), and 6.5 months (95% CI: 4.00–9.80), respectively (P=0.036). Conclusions Anlotinib exhibits good tolerance and performance in prolonging the PFS of patients and has considerable potential as a treatment for advanced NSCLC.
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Affiliation(s)
- Yuejiao Zhong
- Department of Medical Oncology, the Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Qiang Wei
- Department of Ultrasonography, the Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - You Lu
- Department of Intervention, the Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Xiuliang Tang
- Department of Ultrasonography, the Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Zhongqiu Wang
- Department of Chest Surgery, the Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Lingxiang Chen
- Department of Medical Oncology, the Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
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