Results of Surgical Treatment in Patients with Stage IIIB Non-Small-Cell Lung Cancer

Abstract

From 1973 to March 1989, surgical resection was performed in 83 stage IIIB non-small-cell lung cancer patients (81% of all admitted stage IIIB patients). There were 2 operative deaths (2.3%), and complete resection was accomplished in 33 patients. The five-year survival rate of the patients undergoing complete resection was 25%, whereas that of the incomplete resection group was nil (p less than 0.05). Among the 26 patients with invasion of mediastinal structures who underwent complete resection, 3 patients survived for over five years. Two had squamous-cell carcinoma and one had adenocarcinoma, and their tumors involved the left atrium, pulmonary arterial trunk, and superior vena cava, respectively. Among the 6 patients with T4 lesions due to carinal invasion, two patients (one with mucoepidermoid carcinoma and one with squamous-cell carcinoma) have survived for over 8 and 4 years, respectively, after complete resection. There were no long-term survivors among the patients with malignant pleural effusion. Pleuropneumonectomy did not improve survival. Extended lymph-node dissection for N3 disease was only commenced in recent years, so it is not yet clear whether it will affect the survival rate or not. However, 6 out of 19 patients who underwent extended lymph-node dissection including the contralateral lymph-node compartments are still alive, with 23 months being the longest survival. To date, there are 6 three-year survivors among our present series of stage IIIB patients who underwent operative treatment. From these results, it can be concluded that stage IIIB patients should not be uniformly excluded from consideration for surgery, but rather should be evaluated with regard to the possibility of performing complete resection.

Extended resection for lung cancer invading mediastinal organs

“…2 The only 5-year survivors in this study were patients with tracheal invasion. Elsewhere,' 3 5-year survival in tracheal resection patients was reported to about 20%. NO-1 patients may be good candidates for primary surgery.…”

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

“…T4 lesion was originally defined as an unresectable group of locally advanced lung cancer. However, we have proposed that stage IIIB patients should not be uniformly excluded from surgical candidates and that, taking histology in account, the patients should be evaluated an eligibility for complete resection [18]. In fact, there are many reports in the recent years concerning combined resections of carina, heart and great vessel, or vertebral body with moderately favorable outcomes by an aid of assistant devices during the operation.…”

“…For aorta resection, left subclavian artery-descending aorta bypass using Anthrone tube, or left atrium-descending aorta bypass using bio-pump was used. Partial left atrium resection, was done by an aid of extracorporeal circulation [18].…”

Survival Results and Prognostic Factors in T4 N0-3 Non-small Cell Lung Cancer Patients According to the AJCC 7thEdition Staging System

“…In many previous studies, survival extension was shown in a selected group of T4 NSCLC patients who had been operated on (Watanabe et al, 1991;Martini et al, 1994;Izbicki et al, 1995;Bernard et al, 2001;Osaki et al, 2003;Pitz et al, 2003).…”

“…For example, whether the treatment is curative or palliative, T4 diagnosis, the state of lymph nodes, the pathological subgroup type of the tumor, the age at diagnosis, smoking status, co-morbidity, ECOG-PS (Eastern Cooperative Oncology Group Performance Status), and weight loss can all be factors that affect treatment results and survival rates (Watanabe et al, 1991;Martini et al, 1994;Izbicki et al 1995;Bernard et al, 2001;Osaki et al, 2003;Pitz et al, 2003;Gregory et al, 2012). Therefore it is important to identify the factors that affect overall survival (OS) rate and event free survival (EFS) rates for the selection of treatments and differentiation of patients in this heterogeneous group of LA-NSCLC (T4 N0-3 M0) cases.…”