Extended Resection of T4 Lung Cancer with Invasion of the Aorta: Is It Justified?

Shiraishi, Takeshi; Shirakusa, Takayuki; Miyoshi, Tatsu; Yamamoto, Shunsuke; Hiratsuka, Masafumi; Iwasaki, Akito; Kawahara, Kou

doi:10.1055/s-2005-865678

Cited by 26 publications

(27 citation statements)

References 17 publications

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“…Therefore it has been claimed that operative indication should be restricted to patients who were diagnosed clinical N0/1 [10]. Whereas chemotherapy, most likely in its neoadiuvant form has been administered to patients with clinical N2 disease [15] and, was proposed [17] or demanded [12] for pathological N2. Mediastinal lymphadenopathy was diagnosed as clinical N2, when the lymph node had a short diameter of greater than 1.0 cm on the CT image [15], or was confirmed pathological N2 by performing mediastinoscopy [10], [17].…”

Section: Commentmentioning

confidence: 99%

“…Various resection techniques have been refined for locally advanced (T4) tumors, mostly non-small cell lung cancer (NSCLC) with invasion of the carina, vena cava and spine [6]. Regarding T4 tumors, predominantely N2 NSCLC with aortic invasion few reports exist [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17] with limited numbers of patients which were treated with different therapeutic regimens. The studies vary for surgical technique and use of bypass adjuncts, and reveal non-homogeneous early outcome and survival (Table 1 (Tab.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical resection and survival of patients with unsuspected single node positive lung cancer (NSCLC) invading the descending aorta

Wex

Graeter²,

Zaraca³

et al. 2009

GMS Thoracic Surgical Science; 6:Doc02; ISSN 1862-4006

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Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical resection and survival of patients with unsuspected single node positive lung cancer (NSCLC) invading the descending aorta

Wex

Graeter²,

Zaraca³

et al. 2009

GMS Thoracic Surgical Science; 6:Doc02; ISSN 1862-4006

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“…62,64,66,67 In general, the studies reporting higher 5-year OS tend to have lower proportion of patients with N1 or N2 disease. 62,64,66,67 Although resecting lung cancers with significant aortic involvement has traditionally required cardiopulmonary bypass, recent work has shown that these resections can be accomplished with the use of thoracic endovascular stent grafts thereby obviating the need for bypass. 68 These are all retrospective studies and have inherent selection bias.…”

Section: Great Vessel Invasionmentioning

confidence: 99%

MDT lung cancer care: Input from the Surgical Oncologist

2015

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Although there have been many advancements in the multidisciplinary management of non-small cell lung cancer (NSCLC), surgery remains the primary modality of choice for resectable lung cancer when the patient is able to tolerate lung resection physiologically. There have been recent advances in surgical diagnosis and treatment of lung cancer. Increasing use of low-dose computed tomography (CT) screening for lung cancer has resulted in increased detection of small peripheral nodules or semi-solid ground glass opacities. Here, we review different modalities of localization techniques that have been used to aid surgical excisional biopsy when needle biopsy has failed to provide tissue diagnosis. We also report on the current debates regarding the use of sublobar resections for Stage I NSCLC as well as the surgical management of locally advanced NSCLC. Finally, we discuss the complex surgical management of T4 NSCLC lung cancers.

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“…In a series of patients with aorta invasion, Ohta and colleagues 19) reported 5-year survival rates for T4N0 and T4N2-3 disease of 70% and 16.7%, respectively. Furthermore, Shiraishi and colleagues 20) noted that the outcome of complete resection was much better than that of incomplete resection.…”

mentioning

confidence: 99%

“…The above series reported 3-and 5-year survival rates for patients with T4N0-2 tumors as 39%-54% and 10%-22%, respectively, while smaller studies are available, of tumors invading the spine (45 patients) [16][17][18] or aorta (32 patients). 19,20) Lung cancer with spinal involvement usually occurs in the upper thoracic spine and is most frequently seen as a superior sulcus tumor. Grunenwald 16) reported the outcome of 19 patients following radical en bloc resection for lung cancer invading the spine and noted a 5-year survival rate of 14%, while more recent reports 17,18) showed a range of 47% to 66.7% for 5-year survival following en bloc vertebrectomy with induction chemoradiotherapy.…”

mentioning

confidence: 99%

Surgery for T4N0-1 Non-Small Cell Lung Cancer: from Research to Clinical Practice

Chida

2012

ATCS

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The TNM staging classification for lung cancer has been updated in the 7th edition, with the most notable changes for thoracic surgeons related to separation of malignant effusion from T4 to M1a, which enables T4N0-1 to be down-staged from stage IIIB to IIIA. In the 1990s, researchers noted that T4N0-1 is a subset of IIIB in the 6th edition of TNM staging classification with better prognosis following surgery, as a retrospective analysis presented by the Southwest Oncology Group 1) suggested that patients with T4N0-1M0 tumors benefited from preoperative chemoradiotherapy and surgery as compared to chemoradiotherapy alone (2-year survival, 64% vs. 33%).Most patients with involvement of T4 structures also have mediastinal node involvement. These should be treated with chemoradiotherapy, as that is generally recommended for patients with stage IIIB non-small cell lung cancer (NSCLC). However, a select group of patients with T4 involvement and without mediastinal node involvement can be viewed as candidates for surgery.2)The classification of T4 is defined as extending to mediastinum structures. The T4 description has historically been used for locally advanced tumors involving a structure that is considered to be unresectable for curing. Since nonsurgical therapy for T4 tumors is associated with dismal outcome (5-year survival for stage IIIB tumors treated with chemoradiotherapy, 17%-29%),3) thoracic surgeons have attempted resection of supposedly unresectable structures over the past 3 decades. Lung cancer located on the lateral side occasionally invades the chest wall, and that on the medial side can invade the mediastinum, while the oncological behavior may be the same for tumors in both locations. When T4N0 tumors are entirely resected, the prognosis of the affected patient can be similar to that of those with T3N0 tumors, which are classified as stage IIB. Usually, stage IIB NSCLC is indicated for surgery and commonly performed.Although a number of reports have demonstrated the technical feasibility of resection of T4 structures, few have provided long-term survival data. The largest studies of resection for T4 involvement involved carinal resections, usually together with a right pneumonectomy, with 12 series of carinal resections for lung cancer reported since 1980. Four of the largest series 4-7) published since 2000 provided long-term survival data for 395 patients. The 5-year survival rates ranged from 32% to 53% in the N0-1 subset, and 5.3% to 15% in the N2-3 subset. Mortality was from 7.6% to 16% because most cases utilized a sleeve pneumonectomy, and the mortality rate associated with an ordinary pneumonectomy is about 5%, even in Japan. The best 5-year survival rate of 53% came from the largest series and also reported the lowest operative mortality of 7.6%, which suggests that such resections should be undertaken only by experienced surgeons. This may be a reason why T4N0 tumors are not categorized as stage IIB but rather IIIA, in other words, the surgical indication for stage IIIA is only an option ...

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Extended Resection of T4 Lung Cancer with Invasion of the Aorta: Is It Justified?

Abstract: Extended aortic resection with primary lung cancer is complex and possibly high risk, but can achieve long-term survival in selected patients. Surgical resection should be considered as a treatment option for T4 lung cancer for this T4 subcategory.

Cited by 26 publications

References 17 publications

Surgical resection and survival of patients with unsuspected single node positive lung cancer (NSCLC) invading the descending aorta

Surgical resection and survival of patients with unsuspected single node positive lung cancer (NSCLC) invading the descending aorta

MDT lung cancer care: Input from the Surgical Oncologist

Surgery for T4N0-1 Non-Small Cell Lung Cancer: from Research to Clinical Practice

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