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Geraci TC, Ng T. When Is It Safe to Operate for Lung Cancer? Selection of Fiscally Responsible Cardiopulmonary Function Tests for Limited Resection (Wedge Resection and Segmentectomy), Standard Lobectomy, Sleeve Lobectomy, and Pneumonectomy. Thorac Surg Clin 2021; 31:255-263. [PMID: 34304833 DOI: 10.1016/j.thorsurg.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary function testing remains the central determinant of candidacy for pulmonary resection and indicator of perioperative risk. For patients with borderline pulmonary function, exercise testing can help determine surgical candidacy either via stair climbing or by obtaining a maximum oxygen consumption. The Thoracic Revised Cardiac Risk Index should be used to select patients for further cardiac testing. Patient comorbidities, medications, functional limitations, and smoking status are also requisite assessments of the preoperative evaluation that influence perioperative outcomes. A minimally invasive approach to pulmonary resection reduces perioperative risk and may be of most benefit to patients with borderline pulmonary function.
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Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, 530 1st Avenue, Suite 9V, New York, NY 10016, USA
| | - Thomas Ng
- Division of Thoracic Surgery, University of Tennessee Health Science Center College of Medicine, 1325 Eastmoreland Avenue, Suite 460, Memphis, TN 38104, USA.
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Yu X, Gao S, Xue Q, Tan F, Gao Y, Mao Y, Wang D, Zhao J, Li Y, Wang F, Cheng H, Zhao C, Mu J. Development of a nomogram for predicting the operative mortality of patients who underwent pneumonectomy for lung cancer: a population-based analysis. Transl Lung Cancer Res 2021; 10:381-391. [PMID: 33569320 PMCID: PMC7867759 DOI: 10.21037/tlcr-20-561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Although many studies have reported that patients have undergone entire lung removal for lung cancer along with high operative mortality, the trends in the incidence and associated risk factors for operative death have not been explored in a national population-based study. In addition, a clinical decision-making nomogram for predicting postpneumonectomy mortality remains lacking. Methods A total of 10,337 patients diagnosed with lung cancer who underwent pneumonectomy between 1998 and 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) cancer registry. Multivariate logistic regression analysis was used to identify risk factors for predicting operative mortality. Thereafter, these independent predictors were integrated into a nomogram, and bootstrap validation was applied to assess the discrimination and calibration. Additionally, decision curve analysis (DCA) was used to calculate the net benefit of this forecast model. Results The overall postpneumonectomy mortality between 1998 and 2016 was 10.3%, including a 30-day mortality of 4.2%; however, there were statistically significant decreases in the operative death rates from 8.8% in 1998 to 6.7% in 2016 (P=0.009). Higher operative mortality was associated with advanced patients (P<0.001), male sex (P<0.001), right-sided pneumonectomy (P<0.001), squamous cell carcinoma (SCC) (P=0.008), number of positive lymph nodes (npLNs) 5 or greater (P=0.010), and distant metastasis (P<0.001). However, induction radiotherapy (RT) was a protective factor (P<0.001). The nomogram integrating all of the above independent predictors was well calibrated and had a relatively good discriminative ability, with a C-statistic of 0.687 and an area under the receiver operating characteristic (ROC) curve (AUC) of 0.682; moreover, DCA demonstrated that our model was clinically useful. Conclusions If pneumonectomy was considered inevitable, clinical decision-making based on this simple but efficient predictive nomogram could help minimize the risk of operative death and maximize the survival benefit.
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Affiliation(s)
- Xiangyang Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dali Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Cheng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenguang Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jang HS, Moon SK. Preliminary results of tomotherapy for treatment of inoperable recurrent non-small cell lung cancer at bronchial stump site after right pneumonectomy. Contemp Oncol (Pozn) 2015; 19:60-71. [PMID: 26199573 DOI: 10.5114/wo.2015.48179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim of the study This study aimed to prospectively investigate the clinical outcomes of curative radical helical tomotherapy (HT) applied to recurrent non-small cell lung cancer (NSCLC) at the bronchial stump site after right pneumonectomy. After right pneumonectomy, the heart shifted right laterally. The chambers of the heart closed with a recurrent mass at the bronchial stump were the right atrium and left atrium due to right shifting of the heart. The unfavorable bronchial stump recurrent cancer-heart geometry due to a right shift of the heart might serve as a reliable predictor of cardiac morbidity for aggressive radiotherapy. Material and methods The 23 patients received HT for the recurrent NSCLC at the bronchial stump site after right pneumonectomy between 2008 and 2011. The median age of the patients was 65 years (range 56–74). Results We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy. The median conformal index in the 23 plans was 1.21. The mean fraction of primary PTV receiving more than 95% of the prescribed dose was 97.8%. The mean V45, V50, V60 of the heart were 10.5%, 6.5%, 0.2%, respectively. The median follow-up after tomotherapy was 19.86 months. Median survival was 20 months. The 2-year OS was 39.1%. Conclusions The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.
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Toyokawa G, Takenoyama M, Ichinose Y. Multimodality treatment with surgery for locally advanced non-small-cell lung cancer with n2 disease: a review article. Clin Lung Cancer 2014; 16:6-14. [PMID: 25220209 DOI: 10.1016/j.cllc.2014.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
Stage III non-small-cell lung cancer (NSCLC) is composed of a heterogeneous population of lesions (ie, T4N0-3, T3N1-3, and T1a-2aN2-3), which makes it difficult to establish a definitive treatment strategy. Although several retrospective and prospective studies have been conducted to investigate the significance of multimodality treatments with surgery for patients with resectable stage III NSCLC, the role of surgery still remains controversial. In this article, we review the results of retrospective and prospective studies that have investigated the significance of multimodality treatment with surgery for patients with stage III NSCLC, particularly those with mediastinal lymph node metastasis, and the implications for the treatment of this controversial subset of patients.
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Affiliation(s)
- Gouji Toyokawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan.
| | | | - Yukito Ichinose
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
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Saha SP, Kalathiya RJ, Davenport DL, Ferraris VA, Mullett TW, Zwischenberger JB. Survival after Pneumonectomy for Stage III Non-small Cell Lung Cancer. Oman Med J 2014; 29:24-7. [PMID: 24498478 DOI: 10.5001/omj.2014.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/11/2013] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Stage III non-small cell lung cancer (NSCLC) has a poor prognosis. Reports suggest that five-year survival after current treatment is between 14 to 24 percent. The purpose of this retrospective study was to investigate the morbidity and mortality of patients diagnosed with stage III NSCLC and treated with pneumonectomy at the University of Kentucky Medical Center in Lexington, KY. METHODS We reviewed the medical record and tumor registry follow-up data on 100 consecutive patients who underwent pneumonectomy for lung cancer at the University of Kentucky. RESULTS We identified thirty-six patients in stage III who underwent pneumonectomy. Ten patients had surgery only, eight patients received adjuvant chemotherapy, and eighteen patients received neoadjuvant therapy. There was one surgical death in this series. Mean follow-up was 2.9 years. One-, three-, and five-year survival was 66%, 38%, and 38%, respectively. Five-year survival for the group with adjuvant therapy was 60%. CONCLUSION Most lung cancer patients present with advanced disease and the prognosis remains poor. Our experience indicates resection offers an above average chance of long-term survival when supplemented with neoadjuvant and/or adjuvant therapy.
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Affiliation(s)
- Sibu P Saha
- Department of Surgery, University of Kentucky, Lexington, KY
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