Pulmonary resection for lung cancer with malignant pleural disease first detected at thoracotomy

Okamoto, Tatsuro; Iwata, Takekazu; Mizobuchi, Teruaki; Hoshino, Hidehisa; Moriya, Yasumitsu; Yoshida, Shigetoshi; Yoshino, Ichiro

doi:10.1016/j.ejcts.2011.04.010

Cited by 42 publications

(73 citation statements)

References 13 publications

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“…Third, the N factor and EGFR mutation status were not significant prognostic factors in the current study. However, previous studies found that the N factor and EGFR mutation are significant prognostic factors (2,4,10). Additional patient data may be required to arrive at a definitive conclusion regarding whether the N factor and EGFR mutation status may serve as prognostic factors.…”

Section: Discussionmentioning

confidence: 98%

“…In patients with intrathoracic metastasis, when malignant pleural disease (MPD) is first detected at thoracotomy, it is controversial whether the primary lesion should be resected (2). However, primary lesion resection had survival benefits for certain patients with unexpected intraoperatively p r o v e n M P D o r M P D p a t i e n t s w i t h o u t p l e u r a l effusion (3).…”

Section: Introductionmentioning

confidence: 99%

“…However, appropriately selected candidates with stage IV disease may benefit from surgery (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

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Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

et al. 2017

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Background:The standard treatment for patients with stage IV non-small cell lung cancer (NSCLC) is systemic chemotherapy. However, certain patients, such as those with oligometastasis or M1a disease undergo resection of the primary lesion. Results: The median follow-up duration for the 38 patients (27 men) was 17.7 months (range, 1-82.3 months). The T factors were T1/T2/T3/T4 in 4/16/12/6 patients, respectively. The N factors were N0/N1/N2/N3 in 16/8/12/2 patients, respectively. The M factors were M1a/M1b/M1c in 19/13/6 patients, respectively. Of the 19 M1a patients, 11 were classified as cM0. We introduced the novel classification M-better/M-worse. M-better includes cM0 patients and M1b and M1c patients in whom all lesions have been locally controlled. M-worse includes cM1a patients and M1b and M1c patients in whom lesions cannot be locally controlled. The new M-better/M-worse statuses were 24/14 patients, respectively. The histology of NSCLC was adenocarcinoma/squamous cell carcinoma/others in 30/5/3 patients, respectively. The 5-year overall survival rate was 29%, and the median survival time was 725 days. Squamous cell carcinoma and M-worse were significant factors predicting poor outcomes (P=0.0017, P=0.0007, respectively).Conclusions: Even for stage IV NSCLC patients, resection of the primary lesion may be beneficial, especially for those with M-better status and those not diagnosed with squamous-cell carcinoma (SCC).

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

et al. 2017

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“…Among them, whether to undergo surgical resection of the primary tumor or not is still controversial. A few studies have been published while their findings were inconclusive (8)(9)(10)(11)(12)). Yet no randomized controlled trial has been performed to assess the role of primary tumor resection in NSCLC patients with MPD first detected during surgery.…”

Section: Introductionmentioning

confidence: 99%

Should primary tumor be resected for non-small cell lung cancer with malignant pleural disease unexpectedly found during operation?—a systemic review and meta-analysis

Xu¹,

Chen²,

Wang³

et al. 2016

J. Thorac. Dis.

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Background: Non-small cell lung cancer (NSCLC) with malignant pleural disease (MPD) was considered to be contraindication for surgery, but sometimes MPD was unexpectedly found intraoperatively. There was no consensus on the role of surgical intervention on the primary tumor in patients with MPD. The object of this research was to assess whether exairesis of primary tumor could prolong survival time.Methods: A systemic research of literature was performed on the databases of PubMed, Embase and Web of Science. Literatures examining surgical benefit or other prognostic factors among NSCLC patients with MPD unexpectedly found during operations were included. Hazard ratio (HR) with 95% confidence interval (95% CI) as well as P value is applied for prognostic role of surgical removal or other potential factors.Results: Nine articles with a total number of 861 patients fulfilled the eligibility criteria, five of them compared the survival benefit between exploration and resection among NSCLC patients with unexpected MPD, and other studies also investigated the prognostic factors in these patients. There was a significant survival benefit in patients with primary tumor resection (HR =0.443; 95% CI: 0.344-0.571; P<0.001). This role was further detected when stratified by analysis method and ethnicity. Female was an independent favorable predicted factor (HR =0.788; 95% CI: 0.648-0.959; P=0.017) while higher N-stage was a risk factor (HR =1.879; 95% CI: 1.307-2.701; P=0.001). Among patients who received primary tumor resection, higher N-stage was also a risk factor for poorer survival (HR =2.021; 95% CI: 1.496-2.730; P<0.001).Conclusions: Resection of primary tumor, female and lower-N stage were suggested to be beneficial prognostic factor among NSCLC patients who were detected with MPD for the first time in the operating room. And among these people who received surgical removal of primary tumor, lower N-stage also indicated a better survival.

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“…However, recent publications have reported 5-year survival rates of .6% in patients with malignant pleural disease discovered at thoracotomy [169,170]. Five-year survival seems to be better in patients with N0-N1 disease, in those with pleural nodules and those undergoing lobectomy [169,170].…”

Section: Surgery For Stage IV Lung Cancer (Solitary Metastasis)mentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

Eur Respir Rev

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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Pulmonary resection for lung cancer with malignant pleural disease first detected at thoracotomy

Abstract: The prognosis of patients with surgically detected MPD, who underwent resection, was better than that of M1b patients. MPE patients with N0-1 disease may be candidates for resection.

Cited by 42 publications

References 13 publications

Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

Should primary tumor be resected for non-small cell lung cancer with malignant pleural disease unexpectedly found during operation?—a systemic review and meta-analysis

Surgery for nonsmall cell lung cancer

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