Lung cancer with chest wall invasion: retrospective analysis comparing en-bloc resection and ‘resection in bird cage’

Abstract

BackgroundInvasion of the chest wall per se is not a contraindication for tumor resection in non-small cell lung cancer (NSCLC), provided there is no mediastinal lymph node or vital structure involvement. Although widely known to Brazilian surgeons, the ‘resection in bird cage’ technique has never been widely studied in terms of patient survival. Thus, the objective of this study was to evaluate the postoperative consequences and overall survival of extra-musculoperiosteal resection compared with en-bloc resection in NSCLC patients with invasion of the endothoracic fascia.MethodsBetween January 1990 and December 2009, 33 NSCLC patients with invasion of the thoracic wall who underwent pulmonary resection were retrospectively analyzed. Of the 33 patients evaluated, 20 patients underwent en-bloc resection and 13 underwent ‘resection in bird cage.’ For each patient, a retrospective case note review was made.ResultsThe median age at surgery, gender, indication, rate of comorbidities, tumor size and the degree of uptake in the costal margin were similar for both groups. The rate of postoperative complications and the duration of hospitalization did not differ between the groups. Regarding the outcome variables, the disease-free interval, rate of local recurrence, metastasis-free time after surgery, overall mortality rate, mortality rate related to metastatic disease, duration following surgery in which deaths occurred, and overall survival were also similar between groups. The cumulative survival curves between the ‘resection in bird cage’ and en-bloc resection and between stages Ia + Ib and IIb + IIIa + IV were not significantly different (p = 0.68 and p = 0.64, respectively). The cumulative metastasis-free survival curves were not significantly different between the two types of surgery (p = 0.38).ConclusionsIn NSCLC patients with invasion of the endothoracic fascia, ‘resection in bird cage’ is a less aggressive procedure that yields similar results in terms of morbidity and mortality compared with en-bloc resection. Thus, ‘resection in bird cage’ meets the oncologic principles of resection and does not adversely affect the patients in terms of cure.

Risk factors of chest wall invasion in non-small cell lung cancer

“…First, young patients with NSCLC tended to develop CWI more frequently than older patients in our study. Although the median age of NSCLC patients with CWI was mainly reported to be 60-64 years in previous studies (3,7,8,12,(15)(16)(17)(18)(19), there was no significant difference in the age between the visceral pleural invasion group and the no-pleural invasion group in one study (13). Because whether or not age is a risk factor for CWI in NSCLC patients was not mentioned in previous reports (3,7,8,12,(15)(16)(17)(18)(19), age as a risk factor for CWI in NSCLC patients should be verified in the future.…”

Câncer de pulmão: atualização da terapêutica cirúrgica

“…Os estudos atuais estão demonstrando que as segmetectomias anatômicas (com secção em separado dos vasos e brônquio do segmento pulmonar) possuem o risco de recorrência local semelhante às ressecções tipo lobectomia. 18 A ressecção pulmonar com toracectomia ou com ressecção do diafragma ou do pericárdio podem ser indicadas nos tumores T3.…”

Prediction of pleural invasion using different imaging tools in non-small cell lung cancer

“…The revised staging of NSCLC has a strong impact on the treatment strategies. For example, extrapleural dissection with en-bloc resection were recommended for parietal pleural invasion (7), and lobectomy instead of segmentectomy was recommended in patients with VPI (8). Therefore, noninvasiveness of early lung cancer should be precisely identified in preoperative radiological evaluations, as limited sublobar resection surgery (segmentectomy or wedge resection) is indicated in such cases.…”