Extended resection for lung cancer invading mediastinal organs

Abstract

We analyzed 49 patients with non-small-cell lung cancer invading mediastinal organs such as the left atrium (15), superior vena cava (13), trachea (11), aorta (5), thoracic vertebral body (4) and esophagus (1). Lung resection included lobectomy (37), pneumonectomy (8) and limited resection (4). Twenty-seven patients underwent carina- or bronchoplasty. Complete resection was possible in 35 patients. Operative mortality was 12% and overall 5-year survival was 13%. Median survival time was 519 days. Factors significantly affecting survival were the completeness of resection, node status, and histological type. Five-year survival was 18% with complete resection and 0% with incomplete resection (p < 0.0001). Five-year survival for patients with squamous cell carcinoma was 36% and for those with other types of lung cancer, 0% (p < 0.02). Five-year survival for patients classified pathologically as N0 or N1 was 36% and, for those classified as N2 or N3, 0% (p < 0.05). We concluded that aggressive resection for lung cancer invading the mediastinal organs involves a high mortality rate, making selectivity important. Patients undergoing complete resection, classified as N0 or N1, and having squamouse cell carcinoma may benefit most from surgery.

Surgical management of lung cancer invading the aorta or the superior vena cava

“…Our results on 5-year survival of patients with aorta invasion are in contrast to that reported in previous studies [7]. This should be attributed to the highly selected group of patients in our study [8][9][10][11][12][13]. Previous reports have shown that long-term survival is possible after limited resection of the aortic adventitia along with the primary tumor [7,9,12,[14][15][16].…”

Atrial Resection without Cardiopulmonary Bypass for Lung Cancer

“…MRI may be useful to evaluate the extension of the tumor into the LA. In our experience, the rate of complete resection was 81.8%, which is in line with the rate reported by Doddoli et al 5 (86%), as well as those reported by Bobbio et al 6 (83%), Spaggiari et al 8 (80%), and Galvaing et al 12 (89.4%), and is certainly higher in respect to the R0 rate, around 20%, reported in series including patients treated in the pre CT scan era 21,22 and also in line with other more recent experiences. 9,10 However, in our experience, the group of patients with R0 disease had the best prognosis (55% at 5 years).…”

“…As regards morbidity, our data (36.4%) appear relatively high if compared with current figures in standard lobectomies, but one should consider that patients undergoing LA resection have an increased postoperative risk due to locally more advanced disease. Morbidity and mortality data reported in the literature are quite variable, ranging from 5 to 52.6%, [2][3][4][5][6][7][8][9][10][11][12][18][19][20][21][22] probably due to the heterogeneity of the studied population and perioperative treatments. We did not register any deaths either intraoperatively or postoperatively.…”

Surgical outcomes of N2 and T3-4 non-small cell lung cancer

“…The 5-year survival after left atrium resection was 22%. Takahashi et al [24] reported 53 cases of extended resection of mediastinal organs including left atrium (n = 15), superior vena cava (n = 13), and aorta (n = 5) showed a 5-year survival rate of 13% with 12% operative mortality. However, N0 or N1 cases showed a 36% 5-year survival rate.…”