Risk analysis and long-term survival in patients undergoing extended resection of locally advanced lung cancer

Abstract

Although locally advanced lung cancer frequently necessitates extended resections to preserve a chance for cure, a higher morbidity is associated with extended resections. It is not known whether the increased morbidity is of relevance for the long-term outcome. It also remains unclear whether exclusion of certain patients according to their risk factors can diminish mortality in these patients. This study therefore investigated whether certain risk factors predispose patients undergoing extended pulmonary resections to increased morbidity or mortality. It also assessed the long-term survival. The cases of 126 consecutive patients with locally advanced lung cancer (stage T3 or T4) were prospectively documented. Seventy-five percent of the patients required an extended resection and 25% a nonextended resection. Extended resections were associated with a significantly increased overall morbidity (p < 0.002). However, mortality, severe complications, or multiple complications were not significantly increased after extended resections. No risk factor predisposed to an increased mortality. Risk factors that were associated with particular postoperative complications were pathologic ergonometry (p < 0.002), a positive cardiac score (p < 0.003), coronary artery disease (p = 0.021), and an increased pulmonary risk score (p < 0.05). Overall 3-year survival was 31%. Patients undergoing extended resections for stage T3 or T4 tumors with no residual tumor (70% of the patients) showed a 3-year survival of 33%. We conclude that postoperative mortality cannot be reduced by excluding patients on the basis of particular risk factors from operations that require extended resections. If a patient is considered to be eligible to undergo pulmonary resection, he or she can be considered to be eligible to undergo extended pulmonary resection. Because prognosis is dismal in nonresected locally advanced lung cancer, we recommend an aggressive surgical approach.

Effectiveness of radical en‐bloc‐esophagectomy compared to transhiatal esophagectomy in squamous cell cancer of the esophagus is influenced by nodal micrometastases

“…If the presence of lymphatic microdissemination reflects a systemic dissemination of the disease, which cannot be cured any more by surgery alone, the group of pN1MM À -patients would benefit from TTE, whereas pN1MM þ -patients would not. In accordance with other studies performed in this field [8,[26][27][28] this would explain the potential benefit of the transthoracic approach even in pN1-patients, when patients were stratified only according to their BER-Ep4 status. This analysis showed significantly improved disease-free survival in the micrometastases-free subset of pooled pN0/pN1-patients when operated on transthoracically as compared to the transhiatal approach.…”

Surgical strategies in the therapy of non-small cell lung cancer

“…However, evidence suggests that the mortality rate is not significantly increased after extended resections [78] . For example, Izbicki et al [78] showed in patients undergoing extended resection for stage T3 or T4 NSCLC tumors that the study patients with no residual tumor had a 3-year survival rate of 33%.…”

“…However, evidence suggests that the mortality rate is not significantly increased after extended resections [78] . For example, Izbicki et al [78] showed in patients undergoing extended resection for stage T3 or T4 NSCLC tumors that the study patients with no residual tumor had a 3-year survival rate of 33%. In addition, Spaggiari et al [79] reported a 3-year probability of survival of 39% after extended pneumonectomy with partial resection of the left atrium for advanced lung cancer.…”

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.…”