Surgery for locally advanced non‐small cell lung cancer

Grunenwald, Dominique

doi:10.1002/ssu.10025

Cited by 17 publications

(17 citation statements)

References 47 publications

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“…Vascular resection and reconstruction can be done when need be for lung cancer, particularly superior sulcus tumors, with reasonable postoperative morbidity and mortality, while achieving the goal of complete resection (8). Vertebral body resections in certain circumstances can be done with reasonable postoperative mortality (9). Patients with Pancoast tumors are also the one subset of patients who clearly benefit from induction therapy.…”

Section: Surgery Fort 3 Chest Wall and Superior Sulcusmentioning

confidence: 99%

“…Combined pulmonary and left atrial resection has been described most recently by Bobbio et al (38) with 5-year survival rates of 10% (n = 23). Finally, T 4 lung cancers invading the vertebral body can be resected with a 5-year survival rate of 15% (9). A multidisciplinary team is essential for these complex resections and reconstructions.…”

Section: Atrial Aorta Superior Vena Cava and Vertebral Body Resectmentioning

confidence: 99%

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Surgical Management of T3 and T4 Lung Cancer

DiPerna

Wood

2005

Clinical Cancer Research

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Locally advanced lung cancer (T 3 or T 4 ) has a significantly worse prognosis than lower stage disease. However, this diagnosis is usually made radiologically, and experienced thoracic surgeons are familiar with the low radiologic to pathologic correlation in tumors that abut the great vessels, mediastinum, or chest wall. Commonly these tumors do not directly invade adjacent structures and are, in fact,T 1 orT 2 tumors that are resectable through standard techniques. Where there is no clearly evident invasion of unresectable structures, the patient should be given the benefit of the doubt and considered at a lower (resectable) stage until proven otherwise. The curability of T 3 tumors varies according to the involved site. A T 3 N 0 tumor involving the chest wall provides the most favorable prognosis among the resected T 3 lesions, with a 5-year survival of >50% in lymph node^negative patients if resection is complete. Palliative incomplete resections of T 4 disease, in which tumor has invaded mediastinal structures, have not shown any survival benefit and are associated with very high morbidity and mortality. However, patients with limited invasion of the carina, left atrium, superior vena cava, or pulmonary artery may be able to be completely resected despite their T 4 classification. Surgical resection remains an important part of the therapy for patients with locally advanced lung cancer. Modern techniques of chest wall resection and reconstruction and bronchoplastic procedures allow complete resection of locally advanced tumors with favorable 5-year survival rates and low morbidity and mortality.

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Section: Surgery Fort 3 Chest Wall and Superior Sulcusmentioning

confidence: 99%

Section: Atrial Aorta Superior Vena Cava and Vertebral Body Resectmentioning

confidence: 99%

Surgical Management of T3 and T4 Lung Cancer

DiPerna

Wood

2005

Clinical Cancer Research

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“…5-yr survival rate is reported to be 42% in patients with complete tumor resection and without nodal involvement at the time of surgery [30,31].…”

Section: Stage Iiib -Potentially Resectablementioning

confidence: 99%

“…In potentially resectable T4 (invasion of superior vena cava, carina, lower trachea, left atrium, vertebrae, limited infiltration of the esophagus, satellite nodule in the same lobe) with N0, resection may be performed [11,[30][31][32].…”

Section: Stage Iiib -Potentially Resectablementioning

confidence: 99%

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Diagnosis and treatment of lung cancer – Non-small cell lung cancer, small cell lung cancer and carcinoids

End

2006

Eur Surg

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Zusammenfassung. Grundlagen: Die Prognose von Lungentumoren hängt von der Histologie und dem Tumorstadium ab. Der häufigste Tumortyp ist das nicht-kleinzellige Bronchuskarzinom (NSCLC) mit einer 5-Jahresüber-lebensrate zwischen 67 % (Stadium IA) und < 5 % (Stadium IV).Methodik: Eine rezente Literaturübersicht zeigt diagnostische und therapeutische Standards des nicht-kleinzelligen Bronchuskarzinoms und der neuroendokrinen Tumore (Leitlinien).Ergebnisse: Im Stadium I/II ist bei funktioneller Operabilität eine (Bi)Lobektomie bzw. Pneumonektomie mit systematischer mediastinaler Lymphadenektomie durchzuführen. Im Stadium IIIA (IIIB) erfolgt die Resektion nach neoadjuvanter Chemo(radio)therapie. Thorax-CT, PET und Mediastinoskopie (mediastinale Lymphknoten > 1 cm; PET positiv) sind wichtige Staging-Untersuchungen. Adjuvante Chemotherapien werden im Stadium I/II im Rahmen klinischer Studien durchgeführt. Das kleinzellige Bronchuskarzinom (SCLC, hochmaligner neuroendokriner Tumor Grad III) ist die Domäne der Chemotherapie; Resektionen wie beim NSCLC werden in Frühstadien durchgeführt. Bei den neuroendokrinen Tumoren Grad I (typisches Karzinoid) wird eine parenchymsparende bzw. bronchoplastische Resektion durchgeführt; bei den neuroendokrinen Tumoren Grad II (atypisches Karzinoid) wird wie beim NSCLC vorgegangen.Schlussfolgerungen: Die Inzidenz des Bronchuskarzinoms kann durch Raucherprävention verringert, die Prognose durch Früherkennung und multimodaler Therapie verbessert werden.Schlüsselwörter: Nicht-/kleinzelliges Bronchuskarzinom, neuroendokrine Tumore, Chirurgie, multimodale Therapie.Summary. Background: The prognosis of lung tumors is determined by histology and staging (nodal status). The most common tumor is non-small cell lung carcinoma (NSCLC) with a 5-year survival rate of 67% (stage IA) to < 5% (stage IV).Methods: By reviewing the literature guidelines for diagnosis and treatment of non-small cell lung cancer and neurendocrine tumors are presented.Results: Functional operability provided, (bi)lobectomy or pneumonectomy with mediastinal lymph node dissection are the standard procedures. In case of positive mediastinal lymph nodes (stage IIIA/IIIB) induction chemo(radio)therapy is indicated. Cervical mediastinoscopy is performed in patients with enlarged mediastinal nodes (CT > 1 cm), especially in PET-positive cases. Adjuvant chemotherapy is used in clinical trials. Small-cell lung cancer (SCLC, neuroendocrine tumor grade III) has a poor prognosis, and is treated with chemotherapy; resection may be performed in early stages. Neuroendocrine tumors grade I (typical carcinoid) are resected by segmentectomy, lobectomy, or bronchoplastic resection. Neuroendocrine tumors grade II (atypical carcinoids) are treated like NSCLC.Conclusions: The incidence of lung cancer is decreased by tobacco control, and the chances of survival are improved by early detection and multimodality regimens.

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Robot-assisted thoracic surgery for stages IIB–IVA non-small cell lung cancer: retrospective study of feasibility and outcome

et al. 2023

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Robot-assisted thoracic surgery (RATS) for higher stages non-small cell lung carcinoma (NSCLC) remains controversial. This study reports the feasibility of RATS in patients with stages IIB–IVA NSCLC. A single-institute, retrospective study was conducted with patients undergoing RATS for stages IIB–IVA NSCLC, from January 2015 until January 2020. Unforeseen N2 disease was excluded. Data were collected from the Dutch Lung Cancer Audit database. Conversion rate, radical (R0) resection rate, local recurrence rate and complications were analyzed, as were risk factors for conversion. RATS was performed in 95 patients with NSCLC clinical or pathological stages IIB (N = 51), IIIA (N = 39), IIIB (N = 2) and IVA (N = 3). 10.5% had received neoadjuvant chemoradiotherapy. Pathological staging was T3 in 33.7% and T4 in 34.7%. RATS was completed in 77.9% with a radical resection rate of 94.8%. Lobectomy was performed in 67.4% of the total resections. Conversion was for strategic (18.9%) and emergency (3.2%) reasons. Pneumonectomy (p = 0.001), squamous cell carcinoma (p < 0.001), additional resection of adjacent structures (p = 0.025) and neoadjuvant chemoradiation (p = 0.017) were independent risk factors for conversion. Major post-operative complications occurred in ten patients (10.5%) including an in-hospital mortality of 2.1% (n = 2). Median recurrence-free survival was estimated at 39.4 months (CI 16.4–62.5). Two- and 5-year recurrence-free survival rates were 53.8% and 36.7%, respectively. This study concludes that RATS is safe and feasible in higher staged NSCLC tumors after exclusion of unforeseen N2 disease. It brings new perspective on the potential of RATS in higher stages, dealing with larger and more invasive tumors.

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Surgery for locally advanced non‐small cell lung cancer

Cited by 17 publications

References 47 publications

Surgical Management of T3 and T4 Lung Cancer

Surgical Management of T3 and T4 Lung Cancer

Diagnosis and treatment of lung cancer – Non-small cell lung cancer, small cell lung cancer and carcinoids

Robot-assisted thoracic surgery for stages IIB–IVA non-small cell lung cancer: retrospective study of feasibility and outcome

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