Elucidation of clinicopathological factors associated with improved clinical outcomes for carinal pneumonectomy in T4 non-small cell lung cancer

Abstract

Background: Surgical resection remains the gold standard of care for localized cancers. We retrospectively evaluated the efficacy and safety of carinal pneumonectomy for T4 non-small cell lung cancer (NSCLC), with a focus on the effect of changes in our treatment strategy on the outcome of the procedure over time at a single institution. Methods:The study population consisted of consecutive patients with T4 NSCLC who underwent carinal pneumonectomy at our facility between the period of January 1993 and December 2016.Results: Sixteen patients who underwent carinal pneumonectomy for T4 NSCLC were enrolled. Seven patients were operated before 2000 (the pre-2000 group) and nine were after 2000 (the post-2000 group).The multimodal oncological approach was more frequently used in the post-2000 group (6 patients, 66.6% in the post-2000 group vs. one patient, 14.3% in the pre-2000 group, P=0.04). Two patients (12.5%), both in the pre-2000 group, showed 30-day mortality. In-hospital mortality was found in four patients (25%), three in the pre-2000 group and one in the post-2000. Nine patients (56.4%) developed major postoperative complications. Overall survival for the entire cohort was 61.4% at 1-year, 54.5% at 3-year, and 39.0% at 5-year. Overall survival for the post-2000 group was 88.9% at 1-year, 77.8% at 3-year, and 51.9% at 5-year.Overall survival for the post-2000 group was significantly superior to that of the pre-2000 group (P=0.04).Univariate and multivariate analysis for clinicopathological factors influencing overall survival demonstrated that the multimodal approach had a significant positive impact (P=0.02). Conclusions:In highly selected patients, carinal pneumonectomy for T4 NSCLC could be performed with acceptable postoperative outcomes and favorable survival outcomes. Multimodal approach including salvage surgery after definitive chemoradiation is likely to be associated with good long-term survival.