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Duman S, Erdoğdu E, Özkan B. Double sleeve resections. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S29-S39. [PMID: 38344125 PMCID: PMC10852211 DOI: 10.5606/tgkdc.dergisi.2023.24754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/07/2023] [Indexed: 02/21/2024]
Abstract
Double sleeve lung resections are complex surgical procedures that require specialized surgical expertise and careful patient selection. These procedures allow for the preservation of lung tissue while still achieving complete tumor resection for central tumors. Although initially considered high-risk operations, double sleeve lung resections have become a viable option for central tumors. Recent studies have shown that double sleeve lung resections are associated with lower morbidity and mortality rates than pneumonectomy. Furthermore, double sleeve lung resections may be associated with similar or even better long-term oncological outcomes compared to pneumonectomy, with the added benefit of preserving lung parenchyma and reducing the incidence of postoperative complications.
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Affiliation(s)
- Salih Duman
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
| | - Eren Erdoğdu
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul University Faculty of Medicine, Istanbul, Türkiye
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Matsuo T, Imai K, Takashima S, Kurihara N, Kuriyama S, Iwai H, Tozawa K, Saito H, Nomura K, Minamiya Y. Outcomes and pulmonary function after sleeve lobectomy compared with pneumonectomy in patients with non-small cell lung cancer. Thorac Cancer 2023; 14:827-833. [PMID: 36727556 PMCID: PMC10040283 DOI: 10.1111/1759-7714.14813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sleeve lobectomy is recommended to avoid pneumonectomy and preserve pulmonary function in patients with central lung cancer. However, the relationship between postoperative pulmonary functional loss and resected lung parenchyma volume has not been fully characterized. The aim of this study was to evaluate the relationship between pulmonary function and lung volume in patients undergoing sleeve lobectomy or pneumonectomy. METHODS A total of 61 lung cancer patients who had undergone pneumonectomy or sleeve lobectomy were analyzed retrospectively. Among them, 20 patients performed pulmonary function tests, including vital capacity (VC) and forced expiratory volume in 1 s (FEV1) tests, preoperatively and then about 6 months after surgery. VC and FEV1 ratios were calculated (measured postoperative respiratory function/predicted postoperative respiratory function) as the standardized pulmonary functional loss ratio. RESULTS Thirty-day operation-related mortality was significantly lower after sleeve lobectomy (3.2%) than pneumonectomy (9.6%). The 5-year relapse-free survival rate was 46.67% versus 29.03%, and the 5-year overall survival rate was 63.33% versus 38.71% in patients receiving sleeve lobectomy versus pneumonectomy. The VC ratio in the pneumonectomy group was better than in the sleeve lobectomy group (1.003 ± 0.117 vs. 0.779 ± 0.12; p = 0.0008), as was the FEV1 ratio (1.132 ± 0.226 vs. 0.851 ± 0.063; p = 0.0038). CONCLUSIONS Both short-term and long-term outcomes were better with sleeve lobectomy than pneumonectomy. However, actual postoperative pulmonary function after pneumonectomy may be better than clinicians expect, and pneumonectomy should still be considered a treatment option for patients with sufficient pulmonary reserve and in whom sleeve lobectomy is less likely to be curative.
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Affiliation(s)
- Tsubasa Matsuo
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinogu Takashima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Nobuyasu Kurihara
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shoji Kuriyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hidenobu Iwai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kasumi Tozawa
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University, Yahaba-cho, Japan
| | - Kyoko Nomura
- Department of Health Environmental Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Geropoulos G, Esagian SM, Skarentzos K, Ziogas IA, Katsaros I, Kosmidis D, Tsoulfas G, Lawrence D, Panagiotopoulos N. Video-assisted thoracoscopic versus open sleeve lobectomy for non-small cell lung cancer: A systematic review and meta-analysis from six comparative studies. Asian Cardiovasc Thorac Ann 2022; 30:881-893. [PMID: 36154301 DOI: 10.1177/02184923221115970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
BACKGROUND Lung sleeve resection is indicated for centrally located lung tumors, especially for patients who cannot tolerate pneumonectomy. With video-assisted thoracoscopic surgery (VATS) being increasingly implemented for a wide variety of thoracic pathologies, this study aims to compare the intraoperative, postoperative, and long-term outcomes of VATS and open bronchial sleeve lobectomy for non-small cell lung cancer (NSCLC). METHODS The MEDLINE (via PubMed), Cochrane Library, and Scopus databases were searched. Original clinical studies, comparing VATS and open sleeve lobectomy for NSCLC were included. Evidence was synthesized as odds ratios for categorical and weighted mean difference (WMD) for continuous variables. RESULTS Our analysis included six studies with non-overlapping populations reporting on 655 patients undergoing bronchial sleeve lobectomy for NSCLC (229 VATS and 426 open). VATS sleeve lobectomy was associated with significantly longer operative time ((WMD): 45.85 min, 95% confidence interval (CI): 12.06 to 79.65, p = 0.01) but less intraoperative blood loss ((WMD): -34.57 mL, 95%CI: -58.35 to -10.78, p < 0.001). No significant difference was found between VATS and open bronchial sleeve lobectomy in margin-negative resection rate, number of lymph nodes resected, postoperative outcomes (drainage duration, length of hospital stay, 30-day mortality), postoperative complications (pneumonia, bronchopleural fistula/empyema, prolonged air leakage, chylothorax, pulmonary embolism, and arrhythmia), and long-term outcomes (overall survival, recurrence-free survival). CONCLUSIONS The limitation of our study arises mainly due to the heterogeneity of the included studies. Nevertheless, VATS bronchial sleeve lung resection constitutes a feasible and safe alternative to the open sleeve lung resection surgery for the management of centrally located lung tumors.
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Affiliation(s)
- Georgios Geropoulos
- Department of Thoracic Surgery, 8964University College London Hospitals, NHS Foundation Trust, London, UK
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Stepan M Esagian
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Ioannis Katsaros
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Surgery, 236109Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - David Lawrence
- Department of Thoracic Surgery, 8964University College London Hospitals, NHS Foundation Trust, London, UK
| | - Nikolaos Panagiotopoulos
- Department of Thoracic Surgery, 8964University College London Hospitals, NHS Foundation Trust, London, UK
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Romsa J, Imhoff RJ, Palli SR, Inculet R, Mehta S. SPECT/CT versus planar imaging to determine treatment strategy for non-small-cell lung cancer: a cost-effectiveness analysis. J Comp Eff Res 2022; 11:229-241. [PMID: 35006007 DOI: 10.2217/cer-2021-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: SPECT/CT has been found to improve predicted postoperative forced expiratory volume in one second (ppoFEV1) assessments in patients with non-small-cell lung cancer (NSCLC). Methods: An economic simulation was developed comparing the cost-effectiveness of SPECT/CT versus planar scintigraphy for a US payer. Clinical outcomes and cost data were obtained through review of the published literature. Results: SPECT/CT increased the accuracy ppoFEV1 assessment, changing the therapeutic decision for 1.3% of nonsurgical patients to a surgical option, while 3.3% of surgical patients shifted to more aggressive procedures. SPECT/CT led to an expected cost of $4694 per life year gained, well below typical thresholds. Conclusion: SPECT/CT resulted in substantially improved health outcomes and was found to be highly cost-effective.
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Affiliation(s)
- Jonathan Romsa
- Department of Medical Imaging, Division of Nuclear Medicine, University of Western Ontario, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Ryan J Imhoff
- CTI Clinical Trial & Consulting Services, 100 E. RiverCenter Blvd, Covington, KY 41011, USA
| | - Swetha R Palli
- CTI Clinical Trial & Consulting Services, 100 E. RiverCenter Blvd, Covington, KY 41011, USA
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, University of Western Ontario, 268 Grosvenor Street, St. Joseph's Hospital Rm. E3-117, London, ON N6A 4V2, Canada
| | - Sanjay Mehta
- Department of Medicine, Respirology Division, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
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Yang M, Zhong Y, Deng J, She Y, Zhang L, Wang Y, Zhao M, Hu X, Xie D, Chen C. Comparison of Bronchial Sleeve Lobectomy with Pulmonary Arterioplasty versus Pneumonectomy. Ann Thorac Surg 2021; 113:934-941. [PMID: 33872578 DOI: 10.1016/j.athoracsur.2021.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the efficacy of bronchial sleeve lobectomy with pulmonary arterioplasty by comparing to pneumonectomy in centrally located non-small cell lung cancer (NSCLC) with bronchovascular invasion. METHODS The entire cohort consisted of 212 patients receiving pneumonectomy and 156 patients undergoing bronchial sleeve lobectomy with pulmonary arterioplasty. Propensity score matching was adopted to create a fully balanced cohort, after which, baseline characteristics, perioperative performance and oncological results were compared between two groups. RESULTS Totally 139 pneumonectomy cases were matched with 139 sleeve lobectomy cases. In the matched cohort, bronchial sleeve lobectomy with pulmonary arterioplasty was associated with longer operative time (p<0.001), decreased perioperative transfusion rate (p=0.002), shorter postoperative hospital stays (p<0.001), shorter intensive care unit stays (p=0.040) and lower Clavien-dindo Classification (p=0.016). In respect to survival outcomes, Log-rank test revealed no significant difference in OS (p= 0.381) and RFS (p=0.619) between two surgical procedures. CONCLUSIONS Bronchial sleeve lobectomy with pulmonary arterioplasty could achieve superior perioperative outcomes and equivalent oncological efficacy in comparison with pneumonectomy, indicating that this complex procedure is safe and reliable for centrally located NSCLC concurrently involving the pulmonary artery and bronchus.
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Affiliation(s)
- Minglei Yang
- Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Yang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University.
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SHIMIZU J, MORIYA M, KAMESUI T, NAGAYOSHI T, NONOMURA A, ARANO Y, SHINAGAWA S. Successful left pneumonectomy in a case of giant-sized squamous cell carcinoma of the lung after having difficulty in determining resectability. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jia B, Zheng Q, Li J, Zhao J, Wu M, An T, Wang Y, Zhuo M, Yang X, Chen H, Chi Y, Wang J, Zhai X, He Y, Kong L, Wang Z. Evaluation of different treatment strategies between right-sided and left-sided pneumonectomy for stage I-IIIA non-small cell lung cancer patients. J Thorac Dis 2021; 13:1799-1812. [PMID: 33841969 PMCID: PMC8024865 DOI: 10.21037/jtd-21-264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background This study aimed to assess the different survival outcomes of stage I–IIIA non-small cell lung cancer (NSCLC) patients who received right-sided and left-sided pneumonectomy, and to further develop the most appropriate treatment strategies. Methods We accessed data from the Surveillance, Epidemiology, and End Results database from the United States for the present study. An innovative propensity score matching analysis was used to minimize the variance between groups. Results For 2,683 patients who received pneumonectomy, cancer-specific survival [hazard ratio (HR) =0.863, 95% confidence interval (CI): 0.771 to 0.965, P=0.010] and overall survival (OS; HR =0.875, 95% CI: 0.793 to 0.967, P=0.008) were significantly superior in left-sided pneumonectomy patients compared with right-sided pneumonectomy patients. Cancer-specific survival (HR =0.847, 95% CI: 0.745 to 0.963, P=0.011) and OS (HR =0.858, 95% CI: 0.768 to 0.959, P=0.007) were also significantly longer with left-sided compared to right-sided pneumonectomy after matching analysis of 2,050 patients. Adjuvant therapy could significantly prolong cancer-specific survival (67 versus 51 months, HR =1.314, 95% CI: 1.093 to 1.579, P=0.004) and OS (46 versus 30 months, HR =1.458, 95% CI: 1.239 to 1.715, P<0.001) among left-sided pneumonectomy patients after the matching procedure, while adjuvant therapy did not increase cancer-specific survival for right-sided pneumonectomy patients (46 versus 42 months, HR =1.112, 95% CI: 0.933 to 1.325, P=0.236). Subgroup analysis showed that adjuvant chemotherapy could significantly improve cancer-specific survival and OS for all pneumonectomy patients. However, radiotherapy was associated with worse survival for patients with right-sided pneumonectomy. Conclusions Pneumonectomy side can be deemed as an important factor when physicians determine the most optimal treatment strategies.
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Affiliation(s)
- Bo Jia
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Qiwen Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jianjie Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Zhao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meina Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Tongtong An
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuyan Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Minglei Zhuo
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xue Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hanxiao Chen
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yujia Chi
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jingjing Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoyu Zhai
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuling He
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lingdong Kong
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ziping Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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Guo X, Wang H, Wei Y. [Pneumonectomy for Non-small Cell Lung Cancer: Predictors of Operative Mortality and Survival]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:573-581. [PMID: 32702791 PMCID: PMC7406439 DOI: 10.3779/j.issn.1009-3419.2020.101.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
外科手术是目前根治非小细胞肺癌(non-small cell lung cancer, NSCLC)的最有效方式。全肺切除作为一种术式被应用于临床中。对于中央型肺癌,袖式肺叶切除术因其术后肺功能丧失少、术后并发症及死亡率低逐渐取代全肺切除术成为主流。然而为保证肿瘤学效果,当其他术式无法完全切除时,全肺切除术式仍是必要的。全肺切除术后主要发生心肺并发症,充分了解全肺切除术后相关并发症能帮助临床医师及时做出诊断,并进一步采取相关措施降低术后并发症对患者的不良影响。充分了解预后相关危险因素可帮助临床医师提前采取措施尽可能规避风险,从而改善患者预后。
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Affiliation(s)
- Xiaokang Guo
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Huafeng Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Yucheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
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Peng Q, Zhang L, Ren Y, He W, Xie D, Jiang G, Zhu Y, Zheng H, Chen C. Reconstruction of Long Noncircumferential Tracheal or Carinal Resections With Bronchial Flaps. Ann Thorac Surg 2019; 108:417-423. [PMID: 30928556 DOI: 10.1016/j.athoracsur.2019.02.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/26/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Removal of tumors that invade the trachea or carina often results in a massive defect that exceeds the limits of end-to-end anastomosis. The purpose of this study is to discuss the clinical value of bronchial flap for the closure of central airway defects after noncircumferential tracheal or carinal resection. METHODS From 1990 to 2016, 73 patients underwent noncircumferential tracheal or carinal resection. From size, location, and pulmonary function, there were six different types of bronchial flap reconstruction. RESULTS We performed bronchial flap upturned reconstruction with right pneumonectomy (n = 45), right upper lobectomy (n = 9), left pneumonectomy (n = 7), left upper lobectomy (n = 3), and bronchial flap downturned reconstruction with right pneumonectomy (n = 5), left pneumonectomy (n = 4). The size of airway defects that were replaced by bronchial flap ranged from 0.5 × 2 to 2.5 × 7 cm and was at most 50% of the airway circumference. Postoperative major complications occurred in 17.8% (13 of 73) of patients: four bronchopleural fistulas (5.5%), five serious postoperative infections (6.8%), two pulmonary atelectasis (2.7%), and two airway stenosis (2.7%). However, no significant differences were found in postoperative complications between resection lengths shorter than 4 cm and longer than 4 cm (p = 0.295). The overall 30-day mortality rate was 2.7%. The overall survival rate was 63.5% and 23.6% at 2 and 5 years, respectively. CONCLUSIONS The six different types of bronchial flap reconstruction present an efficient therapeutic strategy to close massive central airway defects after noncircumferential tracheal or carinal resection when the patient has poor pulmonary function or when an end-to-end anastomosis is unfeasible and risky.
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Affiliation(s)
- Qiao Peng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Zheng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Higuchi M, Watanabe M, Endo K, Oshibe I, Soeta N, Saito T, Hojo H, Suzuki H. Wine cup stoma anastomosis after extended sleeve lobectomy for central-type squamous cell lung cancer. J Cardiothorac Surg 2019; 14:36. [PMID: 30755231 PMCID: PMC6373146 DOI: 10.1186/s13019-019-0857-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended sleeve lobectomy is rarely applied to pulmonary surgery for primary lung cancer to avoid a pneumonectomy. As there is a size discrepancy between main bronchus and peripheral bronchus, ingenuity to improve anastomosis is required in the bronchoplasty. We report herein a case in which successful reconstruction of extended sleeve lobectomy with bronchial wall flap. CASE PRESENTATION We report on a 64-year-old man suffering from hemoptysis, cough, mild fever and dyspnea. His computed tomography (CT) scan showed solid tumor of 40 mm in diameter in left lower bronchus, which obstructed the lower bronchus and caused obstructive pneumonia of left lower lobe and expanded to second carina and pulmonary artery. His bronchoscopy showed that tumor was exposed in the bronchial lumen and infiltrated to left main bronchus and upper bronchus even though the scope could pass through the exposed tumor of upper bronchus. Transbronchial lung biopsy showed squamous cell carcinoma. He had undergone left sleeve lingular segmentectomy and left lower lobectomy. Reconstruction was performed with bronchial wall flap. Pathological findings revealed pT3N0M0 stage IIB according to UICC 8th edition. Postoperative bronchoscopic findings showed no troubles at the anastomotic site. He has been well for eighteen months without recurrence after surgery. CONCLUSIONS We experienced a successful case who was reconstructed with bronchial wall flap (wine cup stoma) after extended sleeve lobectomy. This technique might be also useful for other types of extended sleeve lobectomy and lung transplantation to adjust caliber changes of bronchi.
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Affiliation(s)
- Mitsunori Higuchi
- Department of Thoracic Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan.
| | - Masayuki Watanabe
- Department of Thoracic Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan.,Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Kotaro Endo
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan
| | - Ikuro Oshibe
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan
| | - Nobutoshi Soeta
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan
| | - Takuro Saito
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan
| | - Hiroshi Hojo
- Department of Pathology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
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Shah SH, Goel A, Selvakumar V, Garg S, Siddiqui K, Kumar K. Role of pneumonectomy for lung cancer in current scenario: An Indian perspective. Indian J Cancer 2018; 54:236-240. [PMID: 29199698 DOI: 10.4103/0019-509x.219569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Surgical treatment for lung cancer has evolved from pneumonectomy to lobectomy/sleeve resection around the world. Although condemned for poor outcomes, pneumonectomy may still be required in a select group of patients in developing countries. With the better patient selection, optimization of medical comorbidities, better perioperative care; pneumonectomy may show better results. Thus, there is a need to reconsider the role of pneumonectomy in patients with locally advanced lung cancer in the current scenario. PATIENTS AND METHODS The aim of this study was to analyze the demographic and clinicopathologic profile of lung cancer patients and the role of pneumonectomy at a tertiary cancer center in India. The records of patients, who underwent surgery for lung cancer at our institute from January 2011 to April 2014, were analyzed retrospectively, and various parameters in pneumonectomy were compared to lobectomy patients. RESULTS Out of 48 patients undergoing major lung resections, nearly 80% patients were symptomatic at presentation and were mostly in advanced stages, thus requiring neoadjuvant chemotherapy in 45.8% cases and pneumonectomy in 41.6% patients. There was no difference in morbidity and mortality in pneumonectomy (25%, 5%) versus lobectomy (21.2%, 3.5%). Disease-free survival at 1, 2, and 3 years after pneumonectomy (71.8%, 51.4%, and 42.8%) was comparable to lobectomy (73.3%, 66.1%, and 55.6%). After neoadjuvant therapy, survival was not affected by the type of surgery. CONCLUSIONS In the Indian scenario, as the majority of lung cancer patients present at an advanced stage, pneumonectomy still plays a major role, and the acceptable postoperative outcome can be achieved with aggressive perioperative management.
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Affiliation(s)
- S H Shah
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - A Goel
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
| | - Vpp Selvakumar
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - S Garg
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - K Siddiqui
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - K Kumar
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
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Higuchi M, Takagi H, Ozaki Y, Inoue T, Watanabe Y, Yamaura T, Fukuhara M, Muto S, Okabe N, Matsumura Y, Hasegawa T, Osugi J, Hoshino M, Shio Y, Suzuki H. Comparison of surgical outcomes after pneumonectomy and pulmonary function-preserving surgery for non-small cell lung cancer. Fukushima J Med Sci 2018; 64:30-37. [PMID: 29459574 DOI: 10.5387/fms.2017-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND According to previous reports, lobectomy with bronchoplasty or angioplasty is a more feasible surgery than pneumonectomy for central-type non-small cell lung cancer. However, few studies have compared both the short- and long-term outcomes between pneumonectomy and pulmonary function-preserving surgery. METHODS From January 2004 to December 2015, 18 patients underwent pneumonectomy (Group PN) and 12 patients underwent pulmonary function-preserving surgery (group PS) at Fukushima Medical University Hospital. Clinicopathological factors were statistically compared between the two groups. RESULTS The operation times in Group PN and Group PS were 285.9±27.9 and 271.3±99.2 min, respectively (p=0.613), while the amounts of intraoperative bleeding were 324.8±248.9 and 164.5±116.6 g, respectively (p=0.020). The duration of chest drainage and hospitalization after surgery in both groups were not significantly different but there was a tendency toward shorter periods of these durations in Group PS. The 5-year disease-free survival (DFS) rate in Group PN and PS was 51.4% and 74.1%, respectively, without a significant difference (p=0.298). The 5-year overall survival (OS) rate in Group PN and PS was 52.5% and 56.6%, respectively, also without a significant difference (p=0.748). The 5-year OS rate was inferior to the 5-year DFS rate in Group PS, and the 5-year OS rate was not better than the 5-year DFS rate in Group PN. CONCLUSIONS The short-term results were better in Group PS than PN. However, the long-term results in both groups were similar. Other causes of death influenced OS in both groups; this result might have been affected by the surgical procedures.
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Affiliation(s)
- Mitsunori Higuchi
- Department of Thoracic Surgery, Aizu Medical Center, Fukushima Medical University
| | - Hironori Takagi
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Yuki Ozaki
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Takuya Inoue
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Yuzuru Watanabe
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Takumi Yamaura
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Mitsuro Fukuhara
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Satoshi Muto
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Naoyuki Okabe
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Yuki Matsumura
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Takeo Hasegawa
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Jun Osugi
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Mika Hoshino
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Yutaka Shio
- Department of Chest Surgery, Fukushima Medical University School of Medicine
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University School of Medicine
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Tsutsumi K, Matsuya Y, Sugahara T, Tamura M, Sawada S, Fukura S, Nakano H, Date H. Inorganic polyphosphate enhances radio-sensitivity in a human non-small cell lung cancer cell line, H1299. Tumour Biol 2017. [PMID: 28651489 DOI: 10.1177/1010428317705033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Inorganic polyphosphate is a linear polymer containing tens to hundreds of orthophosphate residues linked by high-energy phosphoanhydride bonds. Polyphosphate has been recognized as a potent anti-metastasis reagent. However, the molecular mechanism underlying polyphosphate action on cancer cells is poorly understood. In this study, we investigated the involvement of polyphosphate in radio-sensitivity using a human non-small cell lung cancer cell line, H1299. We found that polyphosphate treatment decreases cellular adenosine triphosphate levels, suggesting a disruption of energy metabolism. We also found that the induction of DNA double-strand breaks was enhanced in polyphosphate-treated cells after X-ray irradiation and colony formation assay revealed that cell survival decreased compared with that of the control groups. These findings suggest that polyphosphate is a promising radio-sensitizer for cancer cells. Therefore, we hypothesized that polyphosphate treatment disrupts adenosine triphosphate-mediated energy transfer for cellular survival and DNA repair, thereby reducing the cellular capability to resist X-ray irradiation.
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Affiliation(s)
- Kaori Tsutsumi
- 1 Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yusuke Matsuya
- 2 Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Manami Tamura
- 4 School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Sawada
- 4 School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sagiri Fukura
- 2 Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hisashi Nakano
- 5 Hiroshima Heiwa Clinic High-Precision Radiotherapy Center, Hiroshima, Japan
| | - Hiroyuki Date
- 1 Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Qadri SSA, Chaudhry MA, Cale A, Cowen ME, Loubani M. Short- and long-term outcomes of pneumonectomy in a tertiary center. Asian Cardiovasc Thorac Ann 2016; 24:250-6. [DOI: 10.1177/0218492316629851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Surgery is the most important therapeutic modality for lung cancer. Surgical outcomes are normally reported as 30-day or 90-day mortality or 5-year survival; 10-year survival is rarely mentioned in national data or international studies. Methods Three hundred and six patients (79% male) underwent pneumonectomy, mainly for lung cancer, from January 1998 to February 2013. Their short- and long-term outcomes up to September 2014 were analyzed retrospectively. The mean age was 64 years (range 22–82 years) and 24% were aged ≥70 years. Thoracoscore was used to calculate the risk of hospital mortality. Results Operative mortality was 4.5% whereas predicted mortality was 8%. The operative mortality for cancer patients was 3.3%; the national mortality for lung cancer is 6.5%. Only 2 patients died in hospital after a pneumonectomy in the last 5 years. Half of the patients who died in hospital were ≥70 years old; 29% (4 patients) died after urgent operations for nonmalignant disease. Overall 5- and 10-year survival was 32% and 20%. Median and mean survival was 26 and 57 months, respectively. Long-term survival was better in females aged <70 years, in left pneumonectomy patients, and in those with squamous cell lung cancer. Conclusion Our mortality for pneumonectomy was 50% less than the national mortality rate and significantly lower than that predicted by the Thoracoscore for lung cancer. This confirms that pneumonectomy is still an effective modality for the treatment of lung cancer, with low operative mortality and good long-term survival, especially in younger patients.
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Affiliation(s)
- Syed SA Qadri
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | | | - Alex Cale
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - Michael E Cowen
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
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Abstract
In this chapter, we discuss the preoperative evaluation that is necessary prior to surgical resection, stage-specific surgical management of lung cancer, and the procedural steps as well as the indications to a variety of surgical approaches to lung resection.
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Affiliation(s)
- Osita I Onugha
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jay M Lee
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Pricopi C, Mordant P, Rivera C, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. Postoperative morbidity and mortality after pneumonectomy: a 30-year experience of 2064 consecutive patients. Interact Cardiovasc Thorac Surg 2014; 20:316-21. [DOI: 10.1093/icvts/ivu417] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ciprian Pricopi
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Pierre Mordant
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Caroline Rivera
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Alex Arame
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Christophe Foucault
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Antoine Dujon
- Department of General Thoracic Surgery, Cedar Surgical Centre, Bois Guillaume, France
| | - Françoise Le Pimpec Barthes
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
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17
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Subotic D, Savic M, Atanasijadis N, Gajic M, Stojsic J, Popovic M, Milenkovic V, Garabinovic Z. Standard versus extended pneumonectomy for lung cancer: what really matters? World J Surg Oncol 2014; 12:248. [PMID: 25086948 PMCID: PMC4244073 DOI: 10.1186/1477-7819-12-248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is still not clear whether an intrapericardial pneumonectomy indicates a more advanced stage of the disease compared to a standard pneumonectomy. METHODS This was a retrospective study of 164 patients who underwent a pneumonectomy for lung cancer. The first group consisted of 82 patients who had a standard pneumonectomy and the second group was 38 patients who had a intrapericardial pneumonectomy, for both groups in the latest 5-year period. The third group was 44 patients with had a sleeve pneumonectomy in the latest 10-year period. The groups were compared in relation to the overall and stage-related survival, influence of T and N factors, operative morbidity and mortality. The statistics used were Kaplan-Meier, U-test, t-test, χ2 test. RESULTS There was no statistically significant difference in stage distribution between standard and intrapericardial pneumonectomies; stages I, II, IIIA and IIIB occurred for 10.9% vs. 2.6%, 30.5% vs. 26.3%, 46.4% vs. 65.8% and 12.2% vs. 5.3% of patients, respectively. For patients who had a sleeve pneumonectomy, stage IIIA was significantly more frequent. Although the overall survival (63.5% vs. 57.6%) and stage-related 5-year survival were better in the first compared to the second group, especially for stage IIIA (58.6% vs. 42.6%), these differences were not statistically significant. There were no significant differences in operative morbidity and mortality between groups 1 and 2, but both were significantly higher in the third group (35.7% and 15.9%). CONCLUSIONS An intrapericardial pneumonectomy does not always indicate a more advanced stage of the disease. The need for an intrapericardial pneumonectomy, either established preoperatively or during the operation, as a single factor, even for marginal surgical candidates, is not strong enough to reject these patients for surgery.
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Affiliation(s)
- Dragan Subotic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, University of Belgrade School of Medicine, Koste Todorovica 26, 11000 Belgrade, Serbia.
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18
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Saha SP, Kalathiya RJ, Davenport DL, Ferraris VA, Mullett TW, Zwischenberger JB. Survival after Pneumonectomy for Stage III Non-small Cell Lung Cancer. Oman Med J 2014; 29:24-7. [PMID: 24498478 DOI: 10.5001/omj.2014.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/11/2013] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Stage III non-small cell lung cancer (NSCLC) has a poor prognosis. Reports suggest that five-year survival after current treatment is between 14 to 24 percent. The purpose of this retrospective study was to investigate the morbidity and mortality of patients diagnosed with stage III NSCLC and treated with pneumonectomy at the University of Kentucky Medical Center in Lexington, KY. METHODS We reviewed the medical record and tumor registry follow-up data on 100 consecutive patients who underwent pneumonectomy for lung cancer at the University of Kentucky. RESULTS We identified thirty-six patients in stage III who underwent pneumonectomy. Ten patients had surgery only, eight patients received adjuvant chemotherapy, and eighteen patients received neoadjuvant therapy. There was one surgical death in this series. Mean follow-up was 2.9 years. One-, three-, and five-year survival was 66%, 38%, and 38%, respectively. Five-year survival for the group with adjuvant therapy was 60%. CONCLUSION Most lung cancer patients present with advanced disease and the prognosis remains poor. Our experience indicates resection offers an above average chance of long-term survival when supplemented with neoadjuvant and/or adjuvant therapy.
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Affiliation(s)
- Sibu P Saha
- Department of Surgery, University of Kentucky, Lexington, KY
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19
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Kalathiya RJ, Davenport D, Saha SP. Long-term survival after pneumonectomy for non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2013; 21:574-81. [PMID: 24570560 DOI: 10.1177/0218492312467025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE to investigate long-term survival in patients who underwent pneumonectomy for non-small-cell lung cancer at the University of Kentucky Medical Center. METHODS we retrospectively reviewed 100 consecutive pneumonectomy cases from 1998 to 2009 at the University of Kentucky. We were able to obtain follow-up data on 99 of 100 patients. RESULTS overall 1-, 2-, and 5-year survival was 66%, 48%, and 32%, respectively. The 1-, 2-, and 5- survival for left pneumonectomy was 76%, 55%, and 40%, respectively, compared to 56%, 44%, and 22%, respectively, for right pneumonectomy. The median survival for left pneumonectomy was 2.4 years compared to 1.2 years for right pneumonectomy (p = 0.056). The 5-year survival for patients diagnosed with stage I disease was 34%, compared to 19% for stage II disease, and 38% for stage III disease. The 5-year survival for patients who underwent neoadjuvant therapy was 31% compared to 39% for patients who received adjuvant therapy and 29% for patients who received surgery alone. These results were also not statistically significant. CONCLUSION neoadjuvant therapy did not adversely affect long-term survival in our study. When compared to left pneumonectomy, right pneumonectomy for non-small-cell lung cancer is associated with adverse postoperative outcomes as well as poorer long-term survival.
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20
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Lee HK, Lee HS, Kim KI, Shin HS, Lee JW, Kim HS, Cho SW. Outcomes of Sleeve Lobectomy versus Pneumonectomy for Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 44:413-7. [PMID: 22324026 PMCID: PMC3270283 DOI: 10.5090/kjtcs.2011.44.6.413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/20/2011] [Accepted: 10/22/2011] [Indexed: 11/23/2022]
Abstract
Background Sleeve lobectomy for lung cancer in close proximity to or involving the carina is widely accepted. Operative morbidity and mortality rates, recurrence, and survival rates have varied considerably across studies. Materials and Methods From March of 2005 to July of 2010, sleeve lobectomy was performed in 19 patients and pneumonectomy was performed in 20 patients. In this paper, the results of sleeve lobectomy and pneumonectomy for patients with lung cancer will be compared and evaluated. Results There were no postoperative complications in either group, but there was one mortality in the pneumonectomy group. There was better preservation of pulmonary function in the sleeve lobectomy group than the pneumonectomy group (p=0.066 in FVC, p=0.019 in FEV1). The 3-year survival rates were 46.7% in the sleeve lobectomy group and 54.5% in the pneumonectomy group (p=0.505). The 3-year disease-free survival rates were 38% in the sleeve lobectomy group and 45.8% in the pneumonectomy group (p=0.200). Conclusion Sleeve lobectomy for lung cancer showed low mortality, low bronchial anastomotic complication rates, and good preservation of pulmonary function.
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Affiliation(s)
- Hong-Kyu Lee
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Korea
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Gunluoglu MZ, Demir A, Turna A, Sansar D, Melek H, Dincer SI, Gurses A. Extent of lung resection in non-small lung cancer with interlobar lymph node involvement. Ann Thorac Cardiovasc Surg 2011; 17:229-35. [PMID: 21697782 DOI: 10.5761/atcs.oa.09.01530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 04/22/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Optimal resection type for non-small cell lung cancer (NSCLC) with interlobar lymph node involvement (ILNI) has seldom been reported. To completely resect a NSCLC with ILNI, some surgeons believe that a pneumonectomy is needed. METHODS We retrospectively studied 151 patients (147 men, 4 women; mean age 58 ± 8 years, range 34-79) with non-small lung cancer without mediastinal or hilar lymph node metastasis who underwent an anatomic lung resection with systematic lymph node dissection between January 1995 and November 2006. All patients had involvement of the surgical-pathologic interlobar (#11) lymph node: 8 patients had a T1 tumor; 95, T2; 39, T3; and 9, T4. We evaluated the effect of resection type (pneumonectomy in 90 patients versus lobectomy in 61) on their prognosis by univariate and multivariate analyses. RESULTS The 5-year survival rate of patients was 61% for the lobectomy and 35% for the pneumonectomy (p = 0.04). We did not find statistically significant differences in sex, median age, distributions of tumor site, histology and differentiation, complete resection rate, N1 involvement status, morbidity and mortality. Patients who underwent the pneumonectomy had larger tumors and more T3 tumors. The T status, multiple levels N1 involvement and histology did not affect survival in the univariate analysis. Multivariate analysis revealed resection type as a significant prognostic factor. CONCLUSIONS Pneumonectomy was not necessary in patients with NSCLC and interlobar lymph node involvement that we had discovered intraoperatively.
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Affiliation(s)
- Mehmet Zeki Gunluoglu
- Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Department of Thoracic Surgery, Istanbul, Turkey.
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Gezer S, Oz G, Findik G, Türüt H, Altinok T, Sirmali M, Gülhan E, Ağaçkiran Y, Kaya S, Taştepe I. Sleeve resections for squamous cell carcinoma of the lung. Heart Lung Circ 2011; 19:549-54. [PMID: 20434399 DOI: 10.1016/j.hlc.2010.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 02/09/2010] [Accepted: 02/21/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sleeve resection is an advanced technique that was developed as an alternative to pneumonectomy. This study evaluated our cases of sleeve resection for squamous cell carcinoma of the lung and compared the outcomes with the literature reports. METHODS In total, 26 bronchial, 5 bronchovascular, and 3 vascular sleeve lobectomies were performed between January 2000 and July 2005 in our clinic. Age, gender, operations, postoperative diagnosis and staging, and postoperative morbidity and mortality were evaluated. RESULTS Sleeve resections were performed in 34 patients. All patients were male, with a mean age of 59.4 years. The operations consisted of 16 right upper, 14 left upper, and 1 left lower sleeve lobectomies and 3 superior sleeve bilobectomies. The most common postoperative pathological staging group was stage IIb (32.3%). Operative mortality was 5.9% (n=2). Postoperative morbidity was 20.5% (n=7), including 4 prolonged air leaks plus empyema, 1 prolonged air leak, 1 postoperative bleeding needing revision, and 1 severe bronchostenosis; of these, 6 had persistent atelectasis. The local tumour recurrence rate was 11.7% (n=4). The median survival time and 5-year survival were 36 months and 42%, respectively. CONCLUSIONS Sleeve resection proved to be good therapy for lung cancer and has a lower morbidity and mortality than standard pneumonectomies and results in better lung function and quality of life. The anastomosis-related complications are experience-related technical complications and training thoracic surgeons to perform SRs at experienced centres will reduce the morbidity associated with SRs.
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Affiliation(s)
- Suat Gezer
- Faculty of Medicine, Clinic of Thoracic Surgery, Düzce University, Düzce, Turkey.
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Sleeve Lobectomy as an Alternative Procedure to Pneumonectomy for Non-small Cell Lung Cancer. J Thorac Oncol 2010; 5:517-20. [DOI: 10.1097/jto.0b013e3181d0a44b] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bagan P, Berna P, Brian E, Crockett F, Le Pimpec-Barthes F, Dujon A, Riquet M. Induction Chemotherapy Before Sleeve Lobectomy for Lung Cancer: Immediate and Long-Term Results. Ann Thorac Surg 2009; 88:1732-5. [DOI: 10.1016/j.athoracsur.2009.06.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 06/23/2009] [Accepted: 06/25/2009] [Indexed: 11/17/2022]
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Alifano M, Cusumano G, Strano S, Magdeleinat P, Bobbio A, Giraud F, Lebeau B, Régnard JF. Lobectomy with pulmonary artery resection: Morbidity, mortality, and long-term survival. J Thorac Cardiovasc Surg 2009; 137:1400-5. [DOI: 10.1016/j.jtcvs.2008.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 09/11/2008] [Accepted: 11/02/2008] [Indexed: 11/16/2022]
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Quality of Life and Mood in Older Patients After Major Lung Resection. Ann Thorac Surg 2009; 87:1007-12; discussion 1012-3. [DOI: 10.1016/j.athoracsur.2008.12.084] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 12/24/2008] [Accepted: 12/26/2008] [Indexed: 11/24/2022]
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Rea F, Marulli G, Schiavon M, Zuin A, Hamad AM, Feltracco P, Sartori F. Tracheal sleeve pneumonectomy for non small cell lung cancer (NSCLC): Short and long-term results in a single institution. Lung Cancer 2008; 61:202-8. [PMID: 18280612 DOI: 10.1016/j.lungcan.2007.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 10/19/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
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Simón C, Moreno N, Peñalver R, González G, Alvarez-Fernández E, González-Aragoneses F. The side of pneumonectomy influences long-term survival in stage I and II non-small cell lung cancer. Ann Thorac Surg 2007; 84:952-8. [PMID: 17720406 DOI: 10.1016/j.athoracsur.2007.04.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 04/15/2007] [Accepted: 04/23/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of pneumonectomy as an independent factor on long-term survival after lung resection for centrally or locally advanced non-small cell lung cancer (NSCLC) remains controversial. The aim of this paper is to study the impact of pneumonectomy, and the influence of side of surgery, on long-term survival in patients with pathologic stage I and II NSCLC. METHODS A retrospective review of a prospective multi-institutional database of patients operated on for lung cancer was undertaken. In all, 1,475 patients with pathologic stage I or II NSCLC were studied (421 underwent pneumonectomy; 1,054 had a lobectomy/bilobectomy). Survival and impact of side of surgery for pneumonectomy and lesser resection groups were analyzed and compared using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS Median survival was worse after pneumonectomy than after less extensive resections for patients overall (33 versus 57 months) and for those with stage I NSCLC (38 versus 70 months); however, median survival was better after pneumonectomy for stage II left tumors (55 versus 19 months). Pneumonectomy was an independent adverse determinant of survival for both stage I right tumors (p < 0.001) and stage I left tumors (p < 0.001), but was associated with improved survival for stage II left tumors (p = 0.009). CONCLUSIONS Pneumonectomy was found to be an independent determinant of survival in patients with stage I and II NSCLC, but results differed for right- and left-sided tumors. Further studies of survival comparing pneumonectomy with lesser resections should differentiate between right and left procedures.
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Affiliation(s)
- Carlos Simón
- Thoracic Surgery Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Kim DJ, Lee JG, Lee CY, Park IK, Chung KY. Long-term survival following pneumonectomy for non-small cell lung cancer: clinical implications for follow-up care. Chest 2007; 132:178-84. [PMID: 17505031 DOI: 10.1378/chest.07-0554] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the risk of overall death in long-term survivors (> 5 years) after pneumonectomy for non-small cell lung cancer (NSCLC), and to establish the optimal follow-up strategy for these patients. METHODS We analyzed a single-center experience with 94 long-term survivors who underwent pneumonectomy (group A) for NSCLC between January 1992 and December 2000. Prospective tumor registry data were compared with data for 147 long-term survivors who underwent lobectomy (group B) during the same period. RESULTS Clinical characteristics at the time of operation differed between the two groups with more squamous histology, larger tumor size, and more advanced stage in group A compared with group B. During follow-up, late lung cancer relapses were rare in both groups (2.1% vs 1.4%), and second primary malignancies were less frequent in group A (2.1% vs 9.5%, p = 0.032). The overall 10-year survival rate was lower in group A than in group B (67.3% vs 82.8%); however, there was no significant difference in lung cancer-specific survival (93.5% vs 95.1%). Intercurrent disease was the leading cause of death in group A (14 patients, 14.9%), most commonly respiratory failure resulting from community-acquired pneumonia. CONCLUSION Late cancer relapse or second primary malignancies were rare in long-term survivors after pneumonectomy, but the overall mortality remained high as a result of intercurrent diseases. Continued surveillance should focus on prevention, early detection and aggressive management of intercurrent disease during follow-up care of these patients.
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Affiliation(s)
- Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, CPO Box 8044, Seoul, Republic of Korea
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Yildizeli B, Fadel E, Mussot S, Fabre D, Chataigner O, Dartevelle PG. Morbidity, mortality, and long-term survival after sleeve lobectomy for non-small cell lung cancer. Eur J Cardiothorac Surg 2006; 31:95-102. [PMID: 17126556 DOI: 10.1016/j.ejcts.2006.10.031] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 10/11/2006] [Accepted: 10/23/2006] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Sleeve lobectomy is a widely accepted procedure for central tumors for which the alternative is pneumonectomy. The purpose of this study is to assess operative mortality, morbidity, and long-term results of sleeve lobectomies performed for non-small cell lung carcinoma (NSCLC). METHODS A retrospective review of 218 patients who underwent sleeve lobectomy for NSCLC between 1981 and 2005 was undertaken. There were 186 (85%) men and 32 women with a mean age of 61.9 years (range, 19-82 years). Eighty patients (36.6%) had a preoperative contraindication to pneumonectomy. Right upper lobectomy was the most common operation (45.4%). Vascular sleeve resection was performed in 28 patients (12.8%) and was commonly associated with left upper lobectomy (n=20; 9.1%; p=0.0001). The histologic type was predominantly squamous cell carcinoma (n=164; 75%), followed by adenocarcinoma (n=46; 21%). Resection was incomplete in nine (4.1%) patients. RESULTS There were nine operative deaths; the operative mortality and the morbidity rates were 4.1% and 22.9%, respectively. A total of 14 (6.4%) patients presented with bronchial anastomotic complications: two were fatal postoperatively, seven patients required reoperation, three required a stent insertion, and two were managed conservatively. Multivariate analysis showed that compromised patients (p=0.001), current smoking (p=0.01), right sided resections (p=0.003), bilobectomy (p=0.03), squamous cell carcinoma (p=0.03), and presence of N1 or N2 disease (p=0.01) were risk factors for mortality and morbidity. Follow-up was complete in 208 patients (95.4%). Overall 5-year and 10-year survival rates were 53% and 28.6%, respectively. After complete resection, recurrence was local in 10 patients, mediastinal in 20, and distant in 25. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0-N1 vs N2; p=0.01) and the stage of the lung cancer (stage I-II vs III, p=0.02). CONCLUSIONS For patients with NSCLC, sleeve lobectomy achieves local tumor control, even in patients with preoperative contraindication to pneumonectomy and is associated with low mortality and bronchial anastomotic complication rates. Postoperative complications are higher in compromised patients, smokers, N disease, right sided resections, bilobectomies, and squamous cell cancers. The presence of N2 disease and stage III significantly worsen the prognosis.
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Affiliation(s)
- Bedrettin Yildizeli
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
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Okamoto J, Onda M, Hirata T, Miyamoto S, Akaishi J, Mikami I, Hirai K, Haraguchi S, Koizumi K, Shimizu K. Dissimilarity in gene expression profiles of lung adenocarcinoma in Japanese men and women. ACTA ACUST UNITED AC 2006; 3:223-35. [PMID: 17081955 DOI: 10.1016/s1550-8579(06)80210-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2006] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although clinical differences in lung cancer between men and women have been noted, few studies have examined the sex dissimilarity using gene expression analysis. OBJECTIVE The purpose of this study was to determine the different molecular carcinogenic mechanisms involved in lung cancers in Japanese men and women. METHODS Patients who received surgery for stage I lung adenocarcinoma were included. RNA was extracted from cancerous and normal tissue, and gene expression was then examined with oligonucleotide microarray analysis. A quantitative polymerase chain reaction assay was performed. RESULTS In a microarray analysis of tissue from 13 men and 6 women, 12 genes were under-expressed and 24 genes were overexpressed in lung adenocarcinoma in women compared with men. Genes related to cell cycle were present in underexpressed genes, and genes related to apoptosis, ubiquitination, and metabolism were observed in overexpressed genes. Of interest among the selected genes were WAP four-disulfide core domain 2 (WFDC2) and major histocompatibility complex, class II, DM alpha (HLA-DMA); these genes were classified into 2 groups by hierarchical clustering analysis. Expression of WFDC2 in nonsmokers was significantly higher than that in smokers (P=0.023). However, there was no significant difference in HLA-DMA expression between smokers and nonsmokers. CONCLUSION Thirty-six genes that characterize lung adenocarcinoma by sex were selected. This information may contribute to the development of novel diagnostic techniques and treatment modalities that consider sex differences in lung adenocarcinoma.
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Affiliation(s)
- Junichi Okamoto
- Department of Surgery II, Nippon Medical School, Tokyo, Japan
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Abstract
We examined whether women's survival from lung cancer is influenced by hormonal factors associated with reproductive events. In all 4235 women and 4797 men born on 1 January 1935 or later with lung cancer diagnosed in 1978-1999 were identified in the Danish Cancer Registry and followed up to 31 December 2002 by linkage to the Central Population Registry. Cox regression analysis was used to estimate hazard rate ratios (HRs), and survival probabilities were calculated. Both nulliparous women and men without children had worse prognoses than those with children (women: HR 1.14; CI 1.03-1.26; men: HR 1.24; CI 1.15-1.34). The 5-year survival rate of nulliparous women with adenocarcinoma was 20.3%, while that for parous women was 20.5%; the corresponding rates for men were 13.0% and 16.6%. The number of children affected the risk for death in both sexes, indicating that the finding is not due to hormonal factors but to unmeasured elements such as socio-economic status or lifestyle factors related to parenthood.
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Affiliation(s)
- Halla Skuladottir
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
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Izquierdo Alonso JL, Sánchez Hernández I, Almonacid Sánchez C. El cáncer de pulmón en la mujer. Arch Bronconeumol 2006. [DOI: 10.1157/13097277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Birim O, Kappetein AP, van Klaveren RJ, Bogers AJJC. Prognostic factors in non-small cell lung cancer surgery. Eur J Surg Oncol 2005; 32:12-23. [PMID: 16297591 DOI: 10.1016/j.ejso.2005.10.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 10/04/2005] [Indexed: 11/17/2022] Open
Abstract
AIMS Complete surgical resection of primary tumours remains the treatment with the greatest likelihood for survival in early-stage non-small cell lung cancer (NSCLC). Although TNM stage is the most important prognostic parameter in NSCLC, additional parameters are required to explain the large variability in postoperative outcome. The present review aims at providing an overview of the currently known prognostic markers for postoperative outcome. METHODS We performed an electronic literature search on the MEDLINE database to identify relevant studies describing the risk factors in NSCLC surgery. The references reported in all the identified studies were used for completion of the literature search. RESULTS Poor pulmonary function, cardiovascular disease, male gender, advanced age, TNM stage, non-squamous cell histology, pneumonectomy, low hospital volume and little experience of the surgeon were identified as risk factors for postoperative outcome. However, with the exception of TNM stage and extent of resection, the literature demonstrates conflicting results on the prognostic power of most factors. The role of molecular biological factors, neoadjuvant treatment and adjuvant treatment is not well investigated yet. CONCLUSIONS The advantage of knowing about the existence of comorbidity and prognostic risk factors may provide the clinician with the ability to identify poor prognostic patients and establish the most appropriate treatment strategy. The assessment of prognostic factors remains an area of active investigation and a promising field of research in optimising therapy of NSCLC patients.
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Affiliation(s)
- O Birim
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
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Regnard JF, Perrotin C, Giovannetti R, Schussler O, Petino A, Spaggiari L, Alifano M, Magdeleinat P. Resection for Tumors With Carinal Involvement: Technical Aspects, Results, and Prognostic Factors. Ann Thorac Surg 2005; 80:1841-6. [PMID: 16242466 DOI: 10.1016/j.athoracsur.2005.04.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2004] [Revised: 04/14/2005] [Accepted: 04/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Resection of tumors with carinal involvement remains a challenge because of specific problems of operative technique and airway management. We reviewed our experience with carinal resection and studied factors influencing postoperative course and long-term survival. METHODS Between 1983 and 2002, 65 patients underwent a carinal resection for non-small-cell lung cancers involving the carina (54 squamous cell carcinomas and 11 adenocarcinomas). RESULTS Fifty-eight right sleeve pneumonectomies and 2 left sleeve pneumonectomies were performed. In addition, five tracheocarinal resections with double bronchial reimplantation (no lung resection) were also performed. The intraoperative airway management consisted of high-frequency jet ventilation in 83% of patients and intermittent conventional ventilation through the operative field in the remaining 17% of patients. Operative mortality was 7.7%. Resection was complete in 61 patients. The overall 5-year and 10-year survival rates were 26.5% and 10.6%, respectively. Patients with N0 or N1 disease had a 5-year survival of 38% compared with 5.3% for those with N2 disease (p < 0.01). At multivariate analysis only nodal status (N0, N1 versus N2; p = 0.0046) had a significant impact on long-term survival. CONCLUSIONS Carinal resection provides acceptable results in terms of operative mortality and long-term survival rates. Patients should be carefully selected and probably enrolled in a multimodality treatment program in case of anticipated mediastinal lymph node involvement.
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Kim YT, Kang CH, Sung SW, Kim JH. Local Control of Disease Related to Lymph Node Involvement in Non-Small Cell Lung Cancer After Sleeve Lobectomy Compared With Pneumonectomy. Ann Thorac Surg 2005; 79:1153-61; discussion 1153-61. [PMID: 15797043 DOI: 10.1016/j.athoracsur.2004.09.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Increasing evidence has suggested that sleeve lobectomy might be a viable alternative procedure for pneumonectomy in non-small cell lung cancer (NSCLC), including patients with adequate pulmonary reserve. This study was designed to compare the outcomes of the two procedures and to determine adequate surgical indications for each procedure. METHODS From January of 1989 to December of 1998, sleeve lobectomy was performed in 49 patients, and 200 patients underwent pneumonectomy for NSCLC. By reviewing the computed tomographic scans, bronchoscopic findings, and operative reports, we selected 49 patients on whom sleeve resection could have been performed. The clinical outcomes of the sleeve lobectomies (SL) and pneumonectomies (PN) were analyzed, particularly in relation to nodal status and recurrence patterns. RESULTS Operative mortality was 6.1% (3 of 49 patients) in the SL group and 4.1% (2 of 49 patients) in the PN group. Mean follow-up period was 51 months (range, 5 to 149). The overall 5-year survival rate was not substantially different between the two groups (SL: 53.7% vs PN: 59.5%, p = 0.510). Recurrence occurred in 57% (26 of 46 patients) of the SL group and in 30% (14 of 47 patients) of the PN group. The 5-year freedom from recurrence rates were better in the PN group (SL: 45.7% vs PN: 67.9%, p = 0.017). Locoregional recurrences occurred in 32.6% (15 of 46 patients) of the SL group and in 8.5% (4 of 47 patients) of the PN group. In multivariate analysis, performing sleeve resection in patients with a positive N1 lymph node was a significant risk factor for developing locoregional recurrence (p = 0.007). CONCLUSIONS Although the overall survival rates were similar, sleeve resection resulted in higher locoregional recurrence, particularly in patients with positive N1 lymph nodes. This finding suggests that sleeve resection should be performed in selected patients, such as those without lymph node metastasis.
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Affiliation(s)
- Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, and Xenotransplantation Research Center, Seoul National University College of Medicine, Seoul, Korea.
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Varela G, Jiménez MF, Novoa N, Aranda JL. [Agreement between type of lung resection planned and resection subsequently performed on lung cancer patients]. Arch Bronconeumol 2005; 41:84-7. [PMID: 15718002 DOI: 10.1016/s1579-2129(06)60402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess agreement between planned lung resections and the type subsequently performed on a series of patients, to assess whether tumor location (central or peripheral) affected the degree of discrepancy, and, in the case of unscheduled pneumonectomies, to examine why the planned resection had to be extended. METHOD Prospective, observational clinical study of 199 patients scheduled for lung cancer surgery. Tumors were preoperatively classified as central or peripheral, and the type of operation planned--lobectomy (or bilobectomy) or pneumonectomy--was compared with the operation finally performed. Rates of agreement and Wilks' lambda statistic were calculated. RESULTS Twenty unscheduled pneumonectomies were performed. Agreement between planned and performed operations was found in 86.9% of cases (76.9% in central tumors and 95.4% in peripheral tumors). Wilks' lambda statistic was 0.38 (0.42 for central tumors and 0.17 for peripheral tumors). Seven unscheduled pneumonectomies were performed due to hilar node involvement. CONCLUSIONS The resections performed differed from the resections initially planned in 13% of the bronchial carcinoma operations, in most cases because the planned lobectomy had to be converted to pneumonectomy, a situation which occurred more often with central tumors and was more often due to direct invasion of anatomic structures rather than hilar spread.
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Affiliation(s)
- G Varela
- Sección de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain.
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Varela G, Jiménez M, Novoa N, Aranda J. Concordancia entre el tipo de resección programada y la efectuada en pacientes con carcinoma pulmonar. Arch Bronconeumol 2005. [DOI: 10.1157/13070804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Surgical resection (usually lobectomy) is considered the treatment of choice for individuals with stage I and II non-small cell lung cancer (NSCLC) and for some patients with resectable stage IIIA NSCLC. However much of the evidence supporting surgery is observational. OBJECTIVES To determine whether, in patients with early stage non-small cell lung cancer, surgical resection of cancer improves disease-specific and all-cause mortality compared with no treatment, radiotherapy or chemotherapy. To compare the effectiveness of different surgical approaches (e.g. lobectomy versus limited resection) in improving disease-specific or all-cause mortality in patients with early stage lung cancer. SEARCH STRATEGY Electronic databases (the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (1966 to December 2003)), bibliographies, handsearching of a journal and discussion with experts were used to identify published and unpublished trials. SELECTION CRITERIA Randomised controlled trials comparing surgery alone (or in combination with other therapy) with non-surgical therapy and randomised trials comparing different surgical approaches. DATA COLLECTION AND ANALYSIS A pooled hazard ratio was calculated where possible. Tests for statistical heterogeneity were performed. MAIN RESULTS Eleven trials were included with a total of 1910 subjects. There were no studies with an untreated control group. In a pooled analysis of three trials, four-year survival was superior in patients with resectable stage I to IIIA NSCLC who underwent resection and complete mediastinal lymph node dissection compared with those undergoing resection and lymph node sampling, the hazard ratio was estimated to be 0.78 (95% CI 0.65-0.93, P = 0.005). A further trial found an increased rate of local recurrence in patients with stage I NSCLC treated with limited resection compared with lobectomy. One small trial found a survival advantage in favour of chemotherapy followed by surgery compared to chemotherapy followed by radiotherapy in patients with stage IIIA NSCLC. However none of the other trials included in the review demonstrated a significant improvement in survival in patients treated with surgery compared with non surgical therapy. Several of the included trials had potential methodological weaknesses. AUTHORS' CONCLUSIONS Conclusions about the efficacy of surgery for local and loco-regional NSCLC are limited by the small number of participants studied to date and potential methodological weaknesses of trials. Current evidence suggests that lung cancer resection combined with complete mediastinal lymph node dissection is associated with a small to modest improvement in survival compared with lung cancer resection combined with systematic sampling of mediastinal nodes in patients with stage I to IIIA NSCLC.
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Affiliation(s)
- R Manser
- Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia, 3050.
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Aguilo R, Minguella J. Short- and long-term mortality after pulmonary resection. Ann Thorac Surg 2004; 79:385-6. [PMID: 15620997 DOI: 10.1016/j.athoracsur.2003.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barlési F, Doddoli C, Greillier L, Astoul P, Giudicelli R, Fuentes P, Thomas P. [Prognostic indicators in stage I non-small cell lung cancer]. Rev Mal Respir 2004; 21:93-103. [PMID: 15260042 DOI: 10.1016/s0761-8425(04)71239-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Determinating the prognosis of patients with stage I non-small cell lung cancer (NSCLC) is a challenge. Since up to 30% of patients who have undergone surgical resection experience recurrence, generally in distant organs, it is reasonable to postulate that neo-adjuvant or adjuvant treatments might be useful. Better knowledge of prognostic factors could perhaps define which patient populations should be targeted with such treatments. STATE OF THE ART Numerous potential prognostic factors, relating to the disease (TNM classification, histology, tumor size, blood vessels invasion, micro-metastasis, serum or molecular markers), the patient (gender, age, co-morbidity) as well as the treatment (delay, resection, lymph node dissection, neo-adjuvant and adjuvant treatments), are discussed. PERSPECTIVES These prognostic factors should be integrated into the design of future clinical trials of chemotherapy and/or radiotherapy attempting to evaluate the effectiveness of various combinations of neo-adjuvant or adjuvant therapies. CONCLUSIONS These factors may offer the opportunity to clinically and biologically characterize the different subgroups of patients, leading to a more rational, and perhaps individualized, choice of therapy.
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Affiliation(s)
- F Barlési
- Département des Maladies Respiratoires, Université de la Méditerrannée, Hôpitaux de Marseille, France.
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Ferguson MK, Lehman AG. Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques. Ann Thorac Surg 2003; 76:1782-8. [PMID: 14667584 DOI: 10.1016/s0003-4975(03)01243-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The choice between sleeve lobectomy and pneumonectomy is controversial for patients with early-stage lung cancer and who have acceptable lung function. METHODS We performed a meta-analysis of results of sleeve lobectomy and pneumonectomy published in English from 1990 to 2003. A decision model was developed with 5-year survival, quality-adjusted life years (QALY), and cost effectiveness as the outcomes, and sensitivity analyses were performed. RESULTS The model favored sleeve lobectomy (3.5 percentage point survival advantage) when the reward was 5-year survival; the results were influenced primarily by the 5-year survival rates for patients who did not develop recurrent cancer. Sleeve lobectomy was strongly favored when the reward was QALY (1.53 QALY advantage). Sleeve lobectomy was more cost effective than pneumonectomy, and had an incremental cost effectiveness ratio of $1,300/QALY. CONCLUSIONS In patients with anatomically appropriate early-stage lung cancer, sleeve lobectomy offers better long-term survival and quality of life than does pneumonectomy and is more cost effective.
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Affiliation(s)
- Mark K Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois 60637, USA.
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Alexiou C, Beggs D, Onyeaka P, Kotidis K, Ghosh S, Beggs L, Hopkinson DN, Duffy JP, Morgan WE, Rocco G. Pneumonectomy for stage i (T1N0 and T2N0) nonsmall cell lung cancer has potent, adverse impact on survival. Ann Thorac Surg 2003; 76:1023-8. [PMID: 14529978 DOI: 10.1016/s0003-4975(03)00883-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgically treated, stage I (T1N0 and T2N0) nonsmall cell lung cancer has a relatively favorable prognosis. Our aim was to determine whether performing a pneumonectomy in this group of patients has an impact on survival. METHODS Four hundred eighty-five patients with stage I nonsmall cell lung cancer undergoing lung resection between 1991 and 2000 were studied. Three hundred seventy-four patients underwent a smaller resection than a pneumonectomy and 111 had a pneumonectomy. RESULTS Patients undergoing less extensive resections were older (mean age, 65 vs 63 years) (p = 0.01); these patients were also more likely to have a history of chronic obstructive airway disease (9% vs 2%) (p = 0.01) or asthma (10% vs 3%) (p = 0.04), nonsquamous cell type (56% vs 27%) (p < 0.0001), and T1 tumor stage (66% vs 17%) (p = 0.002) than patients having a pneumonectomy. Operative mortality was 2.4% versus 8% (p = 0.01). Overall 1-, 3-, and 5-year Kaplan-Meier survival rates (95% confidence interval [CI]) after less extensive resections were 85% (CI, 82% to 90%), 63% (CI, 56% to 69%), and 50% (CI, 42% to 57%), respectively, and after pneumonectomy the survival rates were 66% (CI, 53% to 73%), 47% (CI, 35% to 57%), and 44% (CI, 32% to 55%), respectively (p = 0.0006). When the Cox proportional hazards model was applied to all study patients (n = 485), pneumonectomy (p = 0.001), T2 stage (p = 0.006), older age (p = 0.03), and male gender (p = 0.03) were independent adverse predictors of survival. When the analysis was limited to the patients having T1N0 disease (n = 145), pneumonectomy (p = 0.0008), older age (p = 0.05), and nonsquamous cell type (p = 0.02) were independent adverse determinants of survival. When only the patients with T2N0 disease were analyzed (n = 340), male gender (p = 0.0005) and pneumonectomy (p = 0.01) were independent negative predictors of survival. CONCLUSIONS In this study, the patients who underwent pneumonectomy for stage T1N0 or T2N0 nonsmall cell lung cancer had a significantly poorer survival than those patients who underwent smaller lung resections.
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Affiliation(s)
- Christos Alexiou
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom.
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Stoelben E, Sauerbrei W, Ludwig C, Hasse J. Tumor stage and early mortality for surgical resections in lung cancer. Langenbecks Arch Surg 2003; 388:116-21. [PMID: 12712342 DOI: 10.1007/s00423-003-0354-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Accepted: 12/24/2002] [Indexed: 10/25/2022]
Abstract
BACKGROUND Postoperative mortality rates have been published in relation to operative procedure or preexisting pulmonary and extrapulmonary diseases. We analyzed our patients for the effect of the postoperative tumor stage on perioperative mortality. PATIENTS AND METHODS Retrospective study of all thoracotomies for resections ( n=1281) in primary lung cancer from January 1987 to December 1997. Uni- and multivariate analysis was performed for operative procedure, mortality (30 and 90 days), tumor stage, sex, age, tumor localization, and completeness of resection. Radical resection was achieved in 91.9% of the patients. RESULTS Overall postoperative deaths occurred in 4% and 7.3% of patients after 30 and 90 days respectively. Depending on the operative procedure the mortality after segmental resection ( n=116) was 0.9% and 1.7%, lobectomy ( n=621) 3.0% and 5.7%, sleeve lobectomy ( n=152) 5.3% and 7.9%, and pneumonectomy ( n=314) 6.7% and 12.5%, respectively. Within 30 and 90 days postoperatively deaths occurred, respectively, in 0.8% and 1.0% of stage I patients ( n=493), 5.4% and 5.4% of stage II ( n=147), 4.9% and 8.8% of stage IIIa ( n=388), 7.2% and 16.6% of stage IIIb ( n=148), 8.9% and 20.5% and of stage IV ( n=114). Multivariate analysis showed postoperative tumor stage to be the factor most closely related to within the first 90 days. CONCLUSIONS Tumor stage but not type of resection is the strongest predictor of postoperative mortality in these subpopulations.
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Affiliation(s)
- Erich Stoelben
- Department of Thoracic Surgery, University Hospital, 79106, Freiburg, Germany.
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Fadel E, Yildizeli B, Chapelier AR, Dicenta I, Mussot S, Dartevelle PG. Sleeve lobectomy for bronchogenic cancers: factors affecting survival. Ann Thorac Surg 2002; 74:851-8; discussion 858-9. [PMID: 12238850 DOI: 10.1016/s0003-4975(02)03792-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sleeve lobectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and to investigate factors associated with long-term survival. METHODS Between January 1981 and June 2001, 169 patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 139) or carcinoid tumor (n = 30), including 61 with a preoperative contraindication to pneumonectomy. Mean age was 59 +/- 14 years (range, 19 to 82 years). Vascular sleeve resection was performed in 11 patients. The remaining bronchial stump contained microscopic disease in 7 patients. RESULTS Major bronchial anastomotic complications occurred in 6 (3.6%) patients: one was fatal postoperatively, three required reoperation, and two were managed conservatively. In the non-small-cell lung cancer group, operative mortality was 2.9% (4 of 139), and overall 5-year and 10-year survival rates were 52% and 28%, respectively. Six patients experienced local recurrence after complete resection. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0 or N1 versus N2; p = 0.01) and microscopic invasion of the bronchial stump (p = 0.02). In the carcinoid tumor group, there were no operative deaths, and overall 5-year and 10-year survival rates were 100% and 92%, respectively. CONCLUSIONS Sleeve lobectomy achieves local tumor control and is associated with low mortality and bronchial anastomotic complication rates. Long-term survival is excellent for carcinoid tumors. For patients with non-small-cell lung cancer, N2 disease or incomplete resection is associated with a worse prognosis; outcome is not affected by presence of a preoperative contraindication to pneumonectomy.
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Affiliation(s)
- Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
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Rendina EA, Venuta F, de Giacomo T, Rossi M, Coloni GF. Parenchymal sparing operations for bronchogenic carcinoma. Surg Clin North Am 2002; 82:589-609, vii. [PMID: 12371587 DOI: 10.1016/s0039-6109(02)00021-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
By the end of the 1950s, the principles of tracheobronchial and pulmonary artery (PA) reconstruction had been established, and their successful clinical application had taken place. It was not until very recently, however, that these techniques aroused widespread interest among thoracic surgeons as a means to achieve complete cancer resection while preserving functioning lung parenchyma. At the present time, sleeve resection of the bronchus and/or PA has a definite role in the surgical management of lung cancer. Growing interest in this field is evidenced by an increasing number of technical variations intended to adapt the basic technique to the different anatomical settings. Also pitfalls, complications, and their prevention and treatment are being extensively described. Last but not least, functional and oncological long-term results, comparing favorably with those of more extended resections, are being reported by many groups. This demonstrates that sleeve lobectomy is no longer reserved only for particularly skillful surgeons. Sleeve lobectomy has achieved its rightful position among the techniques commonly used in thoracic surgery after 40 years of improving understanding and alternating enthusiasm and legitimate doubts.
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Affiliation(s)
- Erino A Rendina
- Department of Thoracic Surgery, II Clinica Chirurgica, University La Sapienza, Rome, Italy.
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Martin J, Ginsberg RJ, Venkatraman ES, Bains MS, Downey RJ, Korst RJ, Kris MG, Rusch VW. Long-term results of combined-modality therapy in resectable non-small-cell lung cancer. J Clin Oncol 2002; 20:1989-95. [PMID: 11956257 DOI: 10.1200/jco.2002.08.092] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Assessment of long-term results of combined-modality therapy for resectable non-small-cell lung cancer is hampered by insufficient follow-up and small patient numbers. To evaluate this, we reviewed our collective experience. PATIENTS AND METHODS This study was a retrospective chart review recording demographics, tumor stage, treatment, and outcome of consecutive patients undergoing surgery. Survival was analyzed by Kaplan-Meier, and prognostic factors were analyzed by log-rank and Cox regression. RESULTS From January 1993 to December 1999, 470 patients were treated, with follow-up in 446: 27 stage I, 55 stage II, 316 stage III, 43 stage IV (solitary M1), and five uncertain. Chemotherapy was mitomycin/vinblastine/cisplatin (174 patients [39.0%]), carboplatin/paclitaxel (148 [33.2%]), and other combination (124 [27.8%]); 75 patients (16.8%) received induction radiation. Resection was complete in 77.4%, incomplete in 8.3%, attempted but with gross residual disease afterward in 1.8%, and not performed in 12.6%. Pathologic complete response occurred in 20 patients (4.5%). With median follow-up of 31.0 months for patients still alive, median and 3-year survival for pathologic stages 0, I, II, III, and IV were more than 90 months, 73%; 42 months, 52%; 23 months, 35%; 16 months, 28%; and 16 months, 23% (P <.001). In a multivariate analysis, age, complete resection, pathologic stage, and pneumonectomy, but not induction regimen, significantly influenced survival. CONCLUSION Although pathologic complete response outside the protocol setting is low, survival of this large patient cohort is comparable to that of patients in published combined-modality trials. Survival is significantly influenced by patient age, complete resection, pathologic stage, and pneumonectomy. These results can help guide standard clinical practice and emphasize the need for novel induction regimens.
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Affiliation(s)
- Jocelyne Martin
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Thomas P, Doddoli C, Thirion X, Ghez O, Payan-Defais MJ, Giudicelli R, Fuentes P. Stage I non-small cell lung cancer: a pragmatic approach to prognosis after complete resection. Ann Thorac Surg 2002; 73:1065-70. [PMID: 11996242 DOI: 10.1016/s0003-4975(01)03595-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Long-term results of the surgical treatment of stage I non-small cell lung cancer (NSCLC) are disappointing. METHODS Univariate and multivariate analyses were conducted on 515 consecutive lung resections for stage I NSCLC performed from 1990 to 1999 and identified by reviewing a database into which data were entered prospectively. Tumors were staged as stages IA (n = 147) and IB (n = 348) according to the 1997 UICC (Union Internationale Contre le Cancer) pTNM classification. RESULTS Operative mortality rates were 6.2%, 5.3%, 2.3%, and 0% for pneumonectomy, bilobectomy, lobectomy, and lesser resections, respectively. Overall survival rate was 61.1% (55.8% to 66.5%) at 5 years. Univariate analysis identified three significant adverse prognosticators: arteriosclerosis as comorbidity, pathologic T2 status, and blood vessel invasion. Male sex (p = 0.056) and performance of pneumonectomy (p = 0.057) were at the threshold of statistical significance. At multivariate analysis, three independent prognosticators entered the model: arteriosclerosis, blood vessels invasion, and performance of pneumonectomy. CONCLUSIONS Long-term survival of patients with completely resected stage I NSCLC was adversely influenced in a relatively balanced way by factors related to the clinical status of the patient, to the tumor, and to the treatment.
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Affiliation(s)
- Pascal Thomas
- Department of Thoracic Surgery and Lung Transplantation, Ste Marguerite Hospital, University Méditerranée (Aix-Marseille II), School of Medicine, France.
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