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Fadel E, Decaix V. Current management of anterior Pancoast tumors. JTCVS Tech 2024; 25:190-200. [PMID: 38899110 PMCID: PMC11184882 DOI: 10.1016/j.xjtc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Elie Fadel
- Departments of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
| | - Victor Decaix
- Departments of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
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Creze M, Ghaouche J, Missenard G, Lazure T, Cluzel G, Devilder M, Briand S, Soubeyrand M, Meyrignac O, Carlier RY, Court C, Bouthors C. Understanding a mass in the paraspinal region: an anatomical approach. Insights Imaging 2023; 14:128. [PMID: 37466751 DOI: 10.1186/s13244-023-01462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/10/2023] [Indexed: 07/20/2023] Open
Abstract
The paraspinal region encompasses all tissues around the spine. The regional anatomy is complex and includes the paraspinal muscles, spinal nerves, sympathetic chains, Batson's venous plexus and a rich arterial network. A wide variety of pathologies can occur in the paraspinal region, originating either from paraspinal soft tissues or the vertebral column. The most common paraspinal benign neoplasms include lipomas, fibroblastic tumours and benign peripheral nerve sheath tumours. Tumour-like masses such as haematomas, extramedullary haematopoiesis or abscesses should be considered in patients with suggestive medical histories. Malignant neoplasms are less frequent than benign processes and include liposarcomas and undifferentiated sarcomas. Secondary and primary spinal tumours may present as midline expansile soft tissue masses invading the adjacent paraspinal region. Knowledge of the anatomy of the paraspinal region is of major importance since it allows understanding of the complex locoregional tumour spread that can occur via many adipose corridors, haematogenous pathways and direct contact. Paraspinal tumours can extend into other anatomical regions, such as the retroperitoneum, pleura, posterior mediastinum, intercostal space or extradural neural axis compartment. Imaging plays a crucial role in formulating a hypothesis regarding the aetiology of the mass and tumour staging, which informs preoperative planning. Understanding the complex relationship between the different elements and the imaging features of common paraspinal masses is fundamental to achieving a correct diagnosis and adequate patient management. This review gives an overview of the anatomy of the paraspinal region and describes imaging features of the main tumours and tumour-like lesions that occur in the region.
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Affiliation(s)
- Maud Creze
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France.
- BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Jessica Ghaouche
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Gilles Missenard
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Thierry Lazure
- Department of Pathology, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU Smart Imaging, Bicêtre hospital, Le Kremlin Bicêtre, France
| | - Guillaume Cluzel
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Matthieu Devilder
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Sylvain Briand
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | | | - Olivier Meyrignac
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
- BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Robert-Yves Carlier
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Garches Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Charles Court
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Charlie Bouthors
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
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3
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Inci I. Extended Pulmonary Resection for T4 Non-Small Cell Lung Cancer. PRAXIS 2023; 112:103-110. [PMID: 36722106 DOI: 10.1024/1661-8157/a003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
T4 non-small cell lung cancer is a locally advanced disease with poor prognosis. The operation can be challenging even for an experienced surgeon. N2 disease has been shown repeatedly as a risk factor for poor outcome, and these patients should not be candidates for surgical treatment. Surgery for locally advanced T4 tumors without mediastinal lymph node involvement (T4N0 and T4N1) has been demonstrated to result in good outcomes in carefully selected patients. Patients with T4N0-1M0 should be rejected for surgery only after consulting an expert surgical center. As with other stages, the decision for resectability and surgery should be made by a multidisciplinary team.
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Affiliation(s)
- Ilhan Inci
- Klinik Hirslanden, Chirurgisches Zentrum Zürich, Thoracic Surgery, Zurich, Switzerland
- School of Medicine, University of Zurich, Zurich, Switzerland
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Novellis P, Cannavò L, Lembo R, Evangelista A, Dieci E, Giudici VM, Veronesi G, Luzzati A, Alloisio M, Cariboni U. Surgical and Oncological Outcomes of En-Bloc Resection for Malignancies Invading the Thoracic Spine. J Clin Med 2022; 12:jcm12010031. [PMID: 36614832 PMCID: PMC9820992 DOI: 10.3390/jcm12010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE(S) There is still limited data in the literature concerning the survival of patients with tumors of the thoracic spine. In this study, we analyzed clinical features, perioperative and long-term outcomes in patients who underwent vertebrectomy for cancer. Furthermore, we evaluated the survival and surgical complications. METHODS We retrospectively reviewed all cases of thoracic spinal tumors treated by the same team between 1998 and 2018. We divided them into three groups according to type of tumor (primary vertebral, primary lung and metastases) and compared outcomes. For each patient, Overall Survival (OS) and Cumulative Incidence of Relapse (CIR) were estimated. Complications and survival were analyzed using a logistic model. RESULTS Seventy-two patients underwent thoracic spine surgery (40 in group 1, 16 in each group 2 and 3). Thirty patients died at the end of the observation at a mean follow up time of 60 months (41%). The 5-year overall survival was 72% (95% CI: 0.52-0.84), 20% (95% CI: 0.05-0.43) and 27% (95% CI: 0.05-0.56) for each group, respectively. CIR of group 3 was higher (HR 2.57, 95% CI: 1.22-5.45, p = 0.013). The logistic model revealed that age was related to complications (p = 0.04), while surgery for a type 3 tumor was related to mortality (p = 0.02). CONCLUSIONS Although the cohort size was limited, primary vertebral tumors displayed the best 5-y-OS with an acceptable complications rate. The indication of surgery should be advised by a multidisciplinary team and only for selected cases. Finally, the use of a combined approach does not increase the risk of complications.
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Affiliation(s)
- Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Correspondence: ; Tel.: +39-02-26437202
| | - Luca Cannavò
- Division of Orthopedic Oncology and Spine Reconstructive Surgery (CCOORR), IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Elisa Dieci
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, 20089 Rozzano, Italy
| | - Giulia Veronesi
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alessandro Luzzati
- Division of Orthopedic Oncology and Spine Reconstructive Surgery (CCOORR), IRCCS Galeazzi Orthopedic Institute, 20161 Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, 20089 Rozzano, Italy
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Evolution of the Surgical Management of Lung Cancer Invading the Spine: A Single Center Experience. Curr Oncol 2022; 29:3061-3071. [PMID: 35621638 PMCID: PMC9139927 DOI: 10.3390/curroncol29050248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
For patients with locally advanced non-small cell lung cancer invading the spine, induction chemoradiotherapy combined with radical en bloc resection is the key to obtaining long-term survival. With time, our operative technique evolved to a two-step surgery as we experienced numerous perioperative complications during one step surgery. The aim of our study was to assess postoperative morbimortality and long-term survival of both techniques. We retrospectively reviewed all patients who underwent en bloc resection for lung cancer invading the spine between October 2012 and June 2020. Every patient underwent induction therapy. Sixteen patients were included: nine patients were operated on with one step surgery, seven patients were operated on with two step interventions. Twenty-five percent of patients had major perioperative complications and 56.2% of patients had major post-operative complications. Patients in the “one step” group tended to have more perioperative complications whereas patients in the “two step” group tended to have more post-operative complications. Overall 3-year survival was 40% in the one-step and 86% in the two-step surgery group. Although our practice has been improved by two-step interventions, post-operative morbidity remains significant. As long term survivals are encouraging, this type of treatment should still be proposed for highly selected patients, in specialized centers.
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Complications of Chest Wall Resection in Conjunction with Pulmonary Resection. Thorac Surg Clin 2021; 31:393-398. [PMID: 34696851 DOI: 10.1016/j.thorsurg.2021.07.010] [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: 11/23/2022]
Abstract
Techniques for chest wall resection and reconstruction have evolved over the years. Chest wall resection in conjunction with pulmonary resection has several complications, including pulmonary and infectious. Risk factors for complications are related to the size of the defect, number of ribs resected, and the addition of a pulmonary resection. Material used for reconstruction does not impact the overall complication rate.
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Surgical strategies for primary malignant tumors of the thoracic and lumbar spine. Orthop Traumatol Surg Res 2020; 106:S53-S62. [PMID: 31843511 DOI: 10.1016/j.otsr.2019.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/31/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary malignant tumors of the thoracic and lumbar spine are rare. They are mainly hematologic malignancies and more rarely sarcomas or chordomas. Giant-cell tumors and osteoblastomas, while benign, are locally very aggressive and their excision should be discussed as an option. Other possibilities are tumors from nearby organs invading the spine, which are actually carcinomas, but may benefit from radical excision in select cases. METHODS Excision of these tumors is complex and must be integrated in the diagnostic and therapeutic strategy established by a specific multidisciplinary tumor board at a designated cancer center. Surgical resection must combine tumor excision with long-lasting reconstruction of the spine and neighboring soft tissues. The initial excision must be as complete as possible as the possibilities of repeat excision are nearly impossible if the first resection is not complete. RESULTS An exhaustive preoperative imaging workup is essential for determining the tumor's spread and for determining the best surgical strategy. This will often require participation of other surgical specialties, which are well versed in teamwork. Thanks to this multidisciplinary care, especially the participation of thoracic and plastic surgeons, significant progress has been made recently. The first is the possibility of doing very extensive tumor excisions at the spine and in the neighboring organs, thus expanding the surgical indications to patients who were previously considered as being inoperable. We will discuss the surgical strategy and surgical approaches by spine level. Bone and soft tissue reconstruction is more effective thanks to the introduction of new spinal instrumentation and coverage flaps, which have drastically reduced the intra- and postoperative complications. Lastly, the risk factors for neurological complications are better understood, making them easier to prevent and to treat, if they were to occur. CONCLUSION These advances have translated to better cancer outcomes, especially better control of the tumor with neoadjuvant therapies (targeted chemotherapy) and preoperative conformal radiotherapy.
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En Bloc Resection of Thoracic Tumors Invading the Spine: A Single-Center Experience. Ann Thorac Surg 2019; 108:227-234. [PMID: 30885851 DOI: 10.1016/j.athoracsur.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vertebral involvement by a thoracic tumor has long been considered as a limit to surgical treatment, and despite advances, such an invasive operation remains controversial. The aim of this study was to characterize a single-center cohort and to evaluate the outcome, focusing on survival and complications. METHODS We retrospectively reviewed the data of all patients operated on for tumors involving the thoracic spine in an 8-year period. En bloc resection was generally performed by a double team involving thoracic and orthopedic surgeons. Distant follow-up was recorded for oncologic and functional analysis. RESULTS There were 31 patients operated on. An induction therapy was administered in 20 patients. Spinal resection (mostly including ≥2 vertebral levels) was combined with lobectomy in 48.3% of the patients, and osteosynthesis was required in 22 patients. We observed no in-hospital death and a major complications rate of 32.3%, including 5 patients with early neurologic complications. There were 61.3% primary lung carcinomas, 12.9% extrapulmonary primaries, 9.7% metastases, and 16.1% benign tumors. Mean follow-up was 32.1 months. The 5-year overall survival rate was 81.3% in the entire cohort and 75.0% in patients with a malignant tumor. Occurrence of an early postoperative major complication was the only factor significantly associated with shorter overall survival (p = 0.03). The 5-year disease-free survival rate was 37.0% in malignancies. Delayed complications occurred in 35.5% of patients, including persistent neurologic deficit in 12.9%, instrumentation migration in 19.4%, and local infection in 12.9%. CONCLUSIONS En bloc resection of spinal thoracic tumors offers long-term survival and few recurrences in highly selected patients but is associated with significant delayed mechanical or infectious complications.
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Ilonen I, Jones DR. Initial extended resection or neoadjuvant therapy for T4 non-small cell lung cancer-What is the evidence? ACTA ACUST UNITED AC 2018; 2. [PMID: 30498811 DOI: 10.21037/shc.2018.09.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Locally advanced non-small cell lung cancer (NSCLC) tumors that invade surrounding structures within the chest (T4) are a heterogeneous group, and, as such, there are no straightforward guidelines for their management. Advances in imaging, invasive mediastinal staging, and neoadjuvant therapies have expanded the role of surgery with curative intent for this patient group and have also diminished the rate of explorative thoracotomies. Unlike for T4 superior sulcus tumors, the use of neoadjuvant therapy for central T4 tumors is not clearly defined. The most important determinants of a successful outcome after surgery are achieving an R0 resection and avoiding incidental pathologic N2 disease. Use of neoadjuvant therapy in this setting may yield better outcomes after surgery, as both of these variables can be altered if the tumor responds to neoadjuvant therapy. Moreover, response to induction therapy has been shown to have prognostic value.
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Affiliation(s)
- Ilkka Ilonen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Liang Y, Liu P, Zhou XG, Li XL, Lin H, Chen N, Ge D, Dong J. En Bloc Resection with the Assistance of Video-Assisted Thoracoscopy for Left Lower Lung Cancer Invading Thoracic Vertebrae and Rib: A Case Report. Orthop Surg 2018; 9:391-395. [PMID: 29178305 DOI: 10.1111/os.12353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022] Open
Abstract
Lung cancer invading the spine was previously considered unresectable and fatal and, consequently, there are few reports focusing on tumors located in the lower lung lobe and invading the spine. With the development of spinal instrumentation and surgical techniques, and wider acceptance of spondylectomy by surgeons, radical surgical resection has become feasible. Here, we present a case of a male patient with a left lower lung cancer invading thoracic vertebrae who underwent complete resection with sagittal en bloc hemivertebrectomy with video-assisted thoracoscopy. A 60-year-old man complained of left chest pain for 3 months. Chest computed tomography and thoracic vertebrae magnetic resonance image revealed that a tumor in the left lower lung lobe had invaded the seventh and eighth thoracic vertebrae and the eighth rib. As no lymph node or distant metastasis was detected by positron emission tomography-computed tomography, the patient was diagnosed with left lower lung cancer directly invading the seventh and eighth thoracic vertebrae and the eighth rib (T4N0M0, stage IIIA) instead of metastasizing to the thoracic vertebrae. An en bloc resection of the lung tumor and the involved vertebrae was performed by a thoracic surgeon and orthopaedic surgeon with video-assisted thoracoscopy. Six months after the operation, there was no evidence of local recurrence, and the patient had recovered well. En Bloc resection with video-assisted thoracoscopy for lung cancer invading thoracic vertebrae is a safe and feasible surgical method. This method can significantly improve the safety and convenience of this type of surgery.
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Affiliation(s)
- Yun Liang
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Liu
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Gang Zhou
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi-Lei Li
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nong Chen
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Di Ge
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China
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Lu M, Zhou Z, Lei Z, Li H, Boriani S. Huge myxoid chondrosarcoma expanded into the thoracic cavity with spinal involvement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:25-30. [PMID: 29974237 DOI: 10.1007/s00586-018-5689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/20/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE En bloc resection is the treatment of choice of myxoid chondrosarcoma. These tumors can produce huge masses. Anatomical constraints limit the possibility to perform en bloc resection in the spine. METHODS A very huge myxoid chondrosarcoma (14.2 × 10.8 × 11.4 cm) arising from T2 to T5 and invading the whole higher left pleural cavity was observed. Surgical planning according to WBB staging system was performed. RESULTS The tumor was successfully submitted to en bloc resection achieving a tumor-free margin as demonstrated by the pathologist's report. CONCLUSIONS A careful planning and a multidisciplinary collaboration make possible to perform en bloc resection even in apparently impossible cases.
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Affiliation(s)
- Ming Lu
- Department of Orthopedic, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, 510630, China
| | - Zhongxin Zhou
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zixiong Lei
- Department of Orthopedic, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, 510630, China
| | - Haomiao Li
- Department of Orthopedic, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China. .,Academy of Orthopaedics, Guangdong Province, Guangzhou, 510630, China.
| | - Stefano Boriani
- GSpine4 Spine Surgery Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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Yuan L, Mao Y. [Advance of Treatment for Superior Sulcus Tumor of the Lung]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:493-497. [PMID: 29945709 PMCID: PMC6022026 DOI: 10.3779/j.issn.1009-3419.2018.06.10] [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
肺上沟瘤是指发生在肺上沟区的的支气管源性肿瘤, 是非小细胞肺癌(non-small cell lung cancer, NSCLC)的一个独特的临床亚型, 占肺癌总数不足5%。它常侵犯第1肋、臂丛、锁骨下动静脉、交感神经链、星状神经节和(或)椎体等胸廓入口结构。近几十年, 肺上沟瘤的治疗取得了不断的进展, 最新发布的几个临床试验证实了同期放化疗加手术切除能够改善肿瘤的完整切除率、局部控制率和病理缓解率, 延长患者的总生存时间。已经成为肺上沟瘤的治疗最为有效的方式, 并成为美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)和美国胸科医师协会(American College of Chest Physicians, ACCP)指南推荐的肺上沟瘤治疗方案。本文回顾国内外相关文献, 简要介绍肺上沟瘤手术治疗及综合治疗的进展情况。
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Affiliation(s)
- Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Opitz I, Schneiter D. [Modern Aspects of Lung Cancer Surgery]. PRAXIS 2018; 107:1383-1391. [PMID: 31166876 DOI: 10.1024/1661-8157/a003141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Modern Aspects of Lung Cancer Surgery Abstract. Surgery is still an inherent part of the treatment of non-small cell lung cancer. This article summarizes various aspects of the surgical treatment of early and locally advanced stages of lung cancer. Minimally invasive techniques for lung cancer resection - video- or robotic-assisted - are today standard for early stages. Perioperative mortality is below 1 % and the oncological outcome is equal to open surgery. The learning curve is at 50 VATS lobectomies in a program with a minimum of 25 VATS lobectomies/year to obtain satisfying results. In specialized centers, Locally advanced tumors can be resected technically and oncologically safe, with acceptable morbidity and mortality rates. With careful patient selection and planning, 5-year survival rates can be as high as 48 %.
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Dartevelle PG, Mitilian D, Fadel E. Extended surgery for T4 lung cancer: a 30 years’ experience. Gen Thorac Cardiovasc Surg 2017; 65:321-328. [DOI: 10.1007/s11748-017-0752-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022]
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15
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Solli P, Casiraghi M, Brambilla D, Maisonneuve P, Spaggiari L. Surgical Treatment of Superior Sulcus Tumors: A 15-Year Single-center Experience. Semin Thorac Cardiovasc Surg 2017; 29:79-88. [PMID: 28684003 DOI: 10.1053/j.semtcvs.2017.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/11/2022]
Abstract
This paper reports on the characteristics, treatment modalities, and outcomes of patients with superior sulcus tumors who underwent surgery over a period of 15 years in 1 institution. Clinical records of 94 consecutive patients operated on by the same surgical team for non-small cell lung cancer between July 1998 and December 2013 were retrospectively reviewed. All patients received lung and chest wall en bloc resection. Forty-eight (51%) received induction treatments. Surgery was an anterior approach in 46 patients (48.9%), Paulson incision in 35 (37.2%), and a combined approach in 13 (13.8%). Lung resections were 78 lobectomies (83%), 3 were pneumonectomies (3.2%), 6 were bronchoplastic reconstructions (6.4%), and 7 were wedge resections (7.4%). Nodal dissection was systematic in 96% of patients. The median number of resected ribs was 2 (1-5), chest wall residual defect was reconstructed in 42 patients (44.7%), and 21 patients had an associated vascular resection (22.3%). Resection was radical in 85 patients (90.4%). Overall 90-day mortality was 9.6%. After a median follow-up of 1.9 years, 5-year and 10-year overall survival rates were 35% and 23%, respectively. A lower 5-year survival was observed in patients with nodal disease (48% in N0 vs 18% in N+; P < 0.0001), incomplete resection (21% for incomplete vs 37% for complete resection; P = 0.15), and anteriorly located tumor (anterior vs posterior: 26% vs 50%; P = 0.05). Pancoast tumor is a severe condition, but long-term survival may be achieved in selected cases. Nodal involvement, completeness of resection, and vascular invasion are the most important prognostic factors, and induction treatment may play a role.
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Affiliation(s)
- Piergiorgio Solli
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Daniela Brambilla
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology & Biostatistics, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology, DIPO, University of Milan, Italy
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Single Posterior Approach for En-Bloc Resection and Stabilization for Locally Advanced Pancoast Tumors Involving the Spine: Single Centre Experience. Asian Spine J 2016; 10:1047-1057. [PMID: 27994780 PMCID: PMC5164994 DOI: 10.4184/asj.2016.10.6.1047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/06/2016] [Accepted: 05/28/2016] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Monocentric prospective study. PURPOSE To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors. OVERVIEW OF LITERATURE In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for "en-bloc" resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach. METHODS We included all patients who underwent posterior en-bloc resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation. RESULTS Five patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46-61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8-12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5-7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9-24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment. CONCLUSIONS The posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence.
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Marulli G, Battistella L, Mammana M, Calabrese F, Rea F. Superior sulcus tumors (Pancoast tumors). ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:239. [PMID: 27429965 DOI: 10.21037/atm.2016.06.16] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung, with the potential invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, the superior sulcus tumors cause characteristic symptoms, like arm or shoulder pain or Horner's syndrome. The management of superior sulcus tumors has dramatically evolved over the past 50 years. Originally deemed universally fatal, in 1956, Shaw and Paulson introduced a new treatment paradigm with combined radiotherapy and surgery ensuring 5-year survival of approximately 30%. During the 1990s, following the need to improve systemic as well as local control, a trimodality approach including induction concurrent chemoradiotherapy followed by surgical resection was introduced, reaching 5-year survival rates up to 44% and becoming the standard of care. Many efforts have been persecuted, also, to obtain higher complete resection rates using appropriate surgical approaches and involving multidisciplinary team including spine surgeon or vascular surgeon. Other potential treatment options are under consideration like prophylactic cranial irradiation or the addition of other chemotherapy agents or biologic agents to the trimodality approach.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Lucia Battistella
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Francesca Calabrese
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Mody GN, Bravo Iñiguez C, Armstrong K, Perez Martinez M, Ferrone M, Bono C, Chi JH, Wee JO, Lebenthal A, Swanson SJ, Colson YL, Bueno R, Jaklitsch MT. Early Surgical Outcomes of En Bloc Resection Requiring Vertebrectomy for Malignancy Invading the Thoracic Spine. Ann Thorac Surg 2016; 101:231-6; discussion 236-7. [DOI: 10.1016/j.athoracsur.2015.05.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 11/16/2022]
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Setzer M, Robinson LA, Vrionis FD. Management of locally advanced pancoast (superior sulcus) tumors with spine involvement. Cancer Control 2015; 21:158-67. [PMID: 24667403 DOI: 10.1177/107327481402100209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection. METHODS A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence. RESULTS A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%. CONCLUSIONS Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.
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Affiliation(s)
- Matthias Setzer
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
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Nikolaos P, Vasilios L, Efstratios K, Panagiotis A, Christos P, Nikolaos B, Antonios H, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Machairiotis N, Madesis A, Vretzakis G, Kolettas A, Dimitrios D. Therapeutic modalities for Pancoast tumors. J Thorac Dis 2014; 6 Suppl 1:S180-93. [PMID: 24672693 DOI: 10.3978/j.issn.2072-1439.2013.12.31] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 01/21/2023]
Abstract
A Pancoast tumor, also called a pulmonary sulcus tumor or superior sulcus tumor, is a tumor of the pulmonary apex. It is a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung. It typically spreads to nearby tissues such as the ribs and vertebrae. Most Pancoast tumors are non-small cell cancers. The growing tumor can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or, characteristically, compression of a sympathetic ganglion resulting in a range of symptoms known as Horner's syndrome. Pancoast tumors are named for Henry Pancoast, a US radiologist, who described them in 1924 and 1932.The treatment of a Pancoast lung cancer may differ from that of other types of non-small cell lung cancer (NSCLC). Its position and close proximity to vital structures may make surgery difficult. As a result, and depending on the stage of the cancer, treatment may involve radiation and chemotherapy given prior to surgery. Surgery may consist of the removal of the upper lobe of a lung together with its associated structures as well as mediastinal lymphadenectomy. Surgical access may be via thoracotomy from the back or the front of the chest and modification. Careful patient selection, improvements in imaging such as the role of PET-CT in restaging of tumors, radiotherapy and surgical advances, the management of previously inoperable lesions by a combined experienced thoracic-neurosurgical team and prompt recognition and therapy of postoperative complications has greatly increased local control and overall survival for patients with these tumors.
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Affiliation(s)
- Panagopoulos Nikolaos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Livaditis Vasilios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Koletsis Efstratios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Alexopoulos Panagiotis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Prokakis Christos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Baltayiannis Nikolaos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Hatzimichalis Antonios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Ioanna Kougioumtzi
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Athanasios Madesis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Georgios Vretzakis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Alexandros Kolettas
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Dougenis Dimitrios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
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Steliga MA, Rice DC. Extended Resections for Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Long-Term Outcome after En Bloc Resection of Non–Small-Cell Lung Cancer Invading the Pulmonary Sulcus and Spine. J Thorac Oncol 2013; 8:1538-44. [DOI: 10.1097/01.jto.0000437419.31348.a4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lahon B, Mercier O, Fadel E, Mussot S, Fabre D, Hamdi S, Le Chevalier T, Dartevelle P. Subclavian Artery Resection and Reconstruction for Thoracic Inlet Cancer: 25 Years of Experience. Ann Thorac Surg 2013; 96:983-8; discussion 988-9. [DOI: 10.1016/j.athoracsur.2013.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/06/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Deslauriers J, Tronc F, Fortin D. Management of tumors involving the chest wall including pancoast tumors and tumors invading the spine. Thorac Surg Clin 2013; 23:313-25. [PMID: 23931015 DOI: 10.1016/j.thorsurg.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Bronchogenic carcinomas involving the chest wall include tumors invading the ribs and spine, as well as Pancoast tumors. In the past, such neoplasms were considered to be incurable, but with new multimodality regimens, including induction chemoradiation followed by surgery, they can now be completely resected and patients can benefit from prolonged survival. The most important prognostic factors are the completeness of resection and the pathologic nodal status.
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Affiliation(s)
- Jean Deslauriers
- Division of Thoracic Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, 2725 chemin Sainte-Foy, L-3540, Quebec City, Quebec G1V 4G5, Canada.
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Cartwright N, Coonar AS. Surgery for Lung Cancer. Lung Cancer 2013. [DOI: 10.1002/9781118702857.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Yen YT, Wu MH, Lai WW, Chang JM, Hsu IL, Chen YY, Huang WL, Lee WC, Chang KW, Tseng YL. The Role of Video-Assisted Thoracoscopic Surgery in Therapeutic Lung Resection for Pulmonary Tuberculosis. Ann Thorac Surg 2013. [DOI: 10.1016/j.athoracsur.2012.09.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stoker GE, Buchowski JM, Kelly MP, Meyers BF, Patterson GA. Video-assisted thoracoscopic surgery with posterior spinal reconstruction for the resection of upper lobe lung tumors involving the spine. Spine J 2013; 13:68-76. [PMID: 23295033 DOI: 10.1016/j.spinee.2012.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 08/11/2012] [Accepted: 11/16/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Video-assisted thoracoscopic surgery (VATS) is associated with less morbidity and recovery time compared with traditional open thoracotomy (OT) for the resection of early stage non-small cell lung cancer (NSCLC). Local invasion of NSCLC into adjacent vertebrae confers a TNM T status of T4. Anatomical lobectomy by VATS with simultaneous posterior spinal reconstruction (PSR), as a single procedure, offers advantages to selected patients judged as suitable candidates for resection. PURPOSE To report the preliminary results of a novel, multidisciplinary surgical technique for the treatment of upper lobe lung cancers with direct extension to the spine. STUDY DESIGN Consecutive case series. PATIENT SAMPLE Eight adults who underwent PSR with either VATS or OT for the treatment of a T4 (vertebral body invasion) NSCLC. OUTCOME MEASURES Total operative time, estimated blood loss, length of hospital stay, postoperative tumor recurrence and metastasis, survival, reoperations, and any other intraoperative or postoperative complication. METHODS Eight consecutive patients who underwent instrumented PSR with corpectomy for the treatment of an upper lobe NSCLC at a single institution were identified. Either VATS (n=4) or OT (n=4) was performed at the time of the reconstruction in each patient. All tumors were stage III NSCLC without metastasis. RESULTS Patients who underwent VATS and OT were aged 54±11 and 54±2.9 years, respectively. Mean operative time and blood loss were similar between the groups: VATS: 367±117 minutes versus OT: 518±264 minutes; VATS: 813±463 mL versus OT: 1,250±1,500 mL. Mean follow-up was 16±13 months after surgery. Complications occurred in all eight patients. One OT patient had wound dehiscence requiring a tissue flap, and another suffered from a septic shock. No wound complications developed after VATS. Death secondary to tumor recurrence occurred once in each group. For the six surviving patients, 23±15 months (range, 4.5-43 months) have elapsed since surgery. CONCLUSIONS Video-assisted thoracoscopic surgery with PSR is a novel and viable method for the complete resection of T4 NSCLC.
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Affiliation(s)
- Geoffrey E Stoker
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S. Euclid Ave., West Pavilion Suite 11300, Campus Box 8233, St. Louis, MO 63110, USA
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Ichiki Y, Nagashima A, Yasuda M, Takenoyama M. Analysis of the surgical treatment for superior sulcus tumors. Surg Today 2012; 43:1419-24. [PMID: 23212702 DOI: 10.1007/s00595-012-0431-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 10/01/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was undertaken to assess the mortality, complication, and major morbidity rates of surgical treatment for superior sulcus tumors (SSTs), and to estimate the significance of prognostic factors. METHODS We retrospectively reviewed the hospital records of 50 consecutive patients undergoing surgical treatment for SSTs between 1992 and 2007. The significance of risk factors for an adverse outcome was investigated. RESULTS Both the thirty-day and in-hospital mortality rates were 0 %. Complications developed in 18.0 % (9/50) of the patients. The overall 5-year survival was 32.7 %. Pathological T4 and N1 or more were the risk factors predicting an adverse outcome. Survival was not significantly influenced by the preoperative symptoms, the histological type, the invaded organ or the curability. CONCLUSION Surgical treatment for SSTs is associated with acceptable overall morbidity and mortality rates. However, special care must be taken for the patients with pathological T4 and N1 or higher tumors. Preoperative chemoradiotherapy followed by surgical treatment has become a logical strategy for SSTs. Preoperative chemoradiotherapy for SSTs may yield better results than surgery alone.
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Affiliation(s)
- Yoshinobu Ichiki
- Department of Chest Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan,
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de Perrot M, Rampersaud R. Surgical approaches to apical thoracic malignancies. J Thorac Cardiovasc Surg 2012; 144:72-80. [DOI: 10.1016/j.jtcvs.2012.03.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/14/2012] [Accepted: 03/19/2012] [Indexed: 12/01/2022]
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Kuwata T, Uramoto H, Ohtomo H, Nakamura E, Tanaka F. Total vertebrectomy for non-small cell lung cancer. Case Rep Oncol 2012; 5:267-70. [PMID: 22712015 PMCID: PMC3376335 DOI: 10.1159/000339299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We present a case who had left upper lobectomy with total vertebrectomy after arterial embolization in preparation for intraoperative bleeding. A 35-year-old man complained of left back pain. Chest CT revealed a tumor in S1+2 of the left lung, invading the third thoracic vertebra. As no nodal or distant metastasis was detected, we performed left upper lobectomy and lymph node dissection (ND2a-2) after embolization of the vessels feeding the tumor in order to reduce intraoperative bleeding. In addition, the team of orthopedics performed en bloc resection of the third thoracic vertebra and parts of the left third and fourth ribs. Histological examination of the tumor revealed pleomorphic carcinoma (pT4N0M0, stage IIIA).
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Affiliation(s)
- Taiji Kuwata
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hidetaka Uramoto
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hajime Ohtomo
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Eiichiro Nakamura
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Fadel E, Missenard G, Court C, Mercier O, Mussot S, Fabre D, Dartevelle P. Long-Term Outcomes of En Bloc Resection of Non-Small Cell Lung Cancer Invading the Thoracic Inlet and Spine. Ann Thorac Surg 2011; 92:1024-30; discussion 1030. [DOI: 10.1016/j.athoracsur.2011.04.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/12/2011] [Accepted: 04/15/2011] [Indexed: 10/17/2022]
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Campo-Cañaveral de la Cruz JL, Herrero Collantes J, Sánchez Lorente D, Torres Lanzas J. [Chest wall surgery]. Arch Bronconeumol 2011; 47 Suppl 3:15-24. [PMID: 21640288 DOI: 10.1016/s0300-2896(11)70024-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the numerous differences among the distinct diseases of the chest wall, the surgery of this area shows certain common features. Treatment has progressively changed in the last few years due to advances in diagnostic techniques, minimally invasive procedures and reconstruction materials, and especially due to the multidisciplinary management of many diseases. Nuss' minimally invasive correction of pectus excavatum has gained devotees, although open approaches are performed with increasingly small incisions, almost comparable to the lateral incisions in Nuss' technique. Surgeons supporting the open approach also cite the evident disadvantages of the need for a steel implant for 2 or 3 years and for a second intervention to remove this implant. En-bloc resections with reconstruction using materials, which are increasingly better and covered by myocutaneous grafts in collaboration with plastic surgery departments, constitute a major advance in the treatment of chest wall tumors. Trimodal therapy for Pancoast tumors, consisting of induction chemotherapy and radiotherapy and subsequent surgical treatment of the tumor, currently provides the best results in terms of resectability and survival.
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Caronia FP, Ruffini E, Lo Monte AI. The use of video-assisted thoracic surgery in the management of Pancoast tumors☆. Interact Cardiovasc Thorac Surg 2010; 11:721-6. [DOI: 10.1510/icvts.2010.244657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Parissis H, Young V. Treatment of pancoast tumors from the surgeons prospective: re-appraisal of the anterior-manubrial sternal approach. J Cardiothorac Surg 2010; 5:102. [PMID: 21050456 PMCID: PMC2992054 DOI: 10.1186/1749-8090-5-102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 11/04/2010] [Indexed: 11/23/2022] Open
Abstract
Pancoast tumours are now amenable to multimodality treatment with an acceptable survival. This is because trimodality treatment improves tumor sterilization and hence outcome. Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection.The Anterior-manubrial sternal approach was described more than a decade ago and although this method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels, its popularity has not reached high levels. We felt that by re-addressing this topic we would stimulate reconsideration of the anterior approach.
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Affiliation(s)
| | - Vincent Young
- Cardiothoracic Dept, St James Hospital, Dublin 8, Dublin, Ireland
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Murakami H, Kawahara N, Demura S, Kato S, Yoshioka K, Tomita K. Total en bloc spondylectomy for lung cancer metastasis to the spine. J Neurosurg Spine 2010; 13:414-7. [PMID: 20887137 DOI: 10.3171/2010.4.spine09365] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The prognosis in patients with a distant spinal metastasis from the lung is dismal. The role of radical surgery in such cases has been questioned because of the excessive morbidity, blood loss, and operative time as well as the tumor's extreme malignancy. The purpose of this study was to evaluate the surgical results and the prognosis associated with radical surgery for lung cancer metastasis to the spine in carefully selected patients and to clarify whether there is an indication for radical surgery such as total en bloc spondylectomy (TES) in lung cancer metastasis. METHODS The author performed a retrospective review of patients with lung cancer spinal metastasis treated by TES during a 10-year period. Total en bloc spondylectomy for lung cancer metastasis to the spine was performed in 6 patients without visceral or other bony metastases. Outcome measures were prognostic score, mean survival time, and perioperative complications. The histological type was adenocarcinoma in all 6 cases. In 4 cases the surgical strategy prognostic score was 5. In the other 2 cases the score was 6 because there were skip metastases to adjacent vertebra. In the 2 cases with adjacent vertebral metastasis, the adjacent vertebra was excised en bloc together. RESULTS The mean estimated blood loss was 1076 ml and the mean operative time was 7 hours 20 minutes. Perioperative complications were found in 2 cases. One was deep infection after CSF leakage, and the other was paralysis due to postoperative hematoma. At the end of follow-up period, 4 of 6 patients are still living after a mean of 46.3 months (range 36–62 months). In the other 2 cases, 1 patient died of a heart attack and the other of mediastinitis due to surgical site infection by methicillin-resistant Staphylococcus aureus. In this series, local recurrence was not found. CONCLUSIONS Total en bloc spondylectomy has been shown to be associated with excessive morbidity, blood loss, and operative time; however, the procedure is becoming less invasive. The authors conclude that TES is appropriate in selected cases with controllable primary lung cancer, localized spinal metastasis, and no visceral metastasis. In such patients, improvement in the prognosis can be expected after TES. However, even in selected cases and with skilled surgical technique, the complication rate remains high. Total en bloc spondylectomy should be performed after a thorough discussion of the risks and benefits.
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Affiliation(s)
- Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
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Current treatment concepts of Pancoast tumors. Eur Surg 2010. [DOI: 10.1007/s10353-010-0556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Is There a Standard of Care for the Radical Management of Non-small Cell Lung Cancer Involving the Apical Chest Wall (Pancoast Tumours)? Clin Oncol (R Coll Radiol) 2010; 22:334-46. [DOI: 10.1016/j.clon.2010.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/14/2010] [Accepted: 03/04/2010] [Indexed: 11/18/2022]
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Bolton WD, Rice DC, Goodyear A, Correa AM, Erasmus J, Hofstetter W, Komaki R, Mehran R, Pisters K, Roth JA, Swisher SG, Vaporciyan AA, Walsh GL, Weaver J, Rhines L. Superior sulcus tumors with vertebral body involvement: A multimodality approach. J Thorac Cardiovasc Surg 2009; 137:1379-87. [DOI: 10.1016/j.jtcvs.2009.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 11/24/2008] [Accepted: 01/28/2009] [Indexed: 11/16/2022]
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Anraku M, Waddell TK, de Perrot M, Lewis SJ, Pierre AF, Darling GE, Johnston MR, Zener RE, Rampersaud YR, Shepherd FA, Leighl N, Bezjak A, Sun AY, Hwang DM, Tsao MS, Keshavjee S. Induction chemoradiotherapy facilitates radical resection of T4 non–small cell lung cancer invading the spine. J Thorac Cardiovasc Surg 2009; 137:441-447.e1. [DOI: 10.1016/j.jtcvs.2008.09.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 08/27/2008] [Accepted: 09/14/2008] [Indexed: 10/21/2022]
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Yıldızeli B, Dartevelle PG, Fadel E, Mussot S, Chapelier A. Results of Primary Surgery With T4 Non–Small Cell Lung Cancer During a 25-Year Period in a Single Center: The Benefit is Worth the Risk. Ann Thorac Surg 2008; 86:1065-75; discussion 1074-5. [PMID: 18805134 DOI: 10.1016/j.athoracsur.2008.07.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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Jain S, Sommers E, Setzer M, Vrionis F. Posterior midline approach for single-stage en bloc resection and circumferential spinal stabilization for locally advanced Pancoast tumors. J Neurosurg Spine 2008; 9:71-82. [DOI: 10.3171/spi/2008/9/7/071] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The treatment of Pancoast (superior sulcus) tumors that extensively invade the vertebral column remains controversial. Different surgical approaches involving multistage resection techniques have been previously described for superior sulcus tumors that invade the chest wall and spinal column. Typically a posterior approach to stabilize the spine is followed by a second-stage thoracotomy (posterolateral or trap door) for definitive en bloc resection of stage T4 Pancoast tumors. The authors report and elaborate on a surgical technique successfully used for an en bloc resection as well as spinal stabilization through a single-stage posterior approach without any added morbidity.Two patients with histologically proven Pancoast tumors were treated by single-stage resection and stabilization through a posterior approach at the H. Lee Moffitt Cancer Center. A wedge lung resection or lobectomy was performed by the chest surgeon utilizing the chest wall defect. Placement of an anterior cage (in one case) and posterior cervicothoracic spinal instrumentation (in both cases) was performed during the same operation. Average blood loss was 675 ml and surgical time was 7 hours. The median hospital stay was 9 days (range 7–11 days). Both patients did well postoperatively and were free of recurrence at the 2-year follow-up.Radical resection of Pancoast tumors including lobectomy, chest wall resection, costotransversectomy, and partial or complete vertebrectomy with simultaneous instrumentation for spinal stabilization can be performed through a posterior single-stage approach.
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Affiliation(s)
- Surbhi Jain
- 1NeuroOncology Program,
- 2Department of Neurological Surgery, and
| | - Eric Sommers
- 3Thoracic Oncology Program, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Matthias Setzer
- 1NeuroOncology Program,
- 2Department of Neurological Surgery, and
| | - Frank Vrionis
- 1NeuroOncology Program,
- 2Department of Neurological Surgery, and
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Kappers I, Belderbos JSA, Burgers JA, van Zandwijk N, Groen HJM, Klomp HM. Non-small cell lung carcinoma of the superior sulcus: favourable outcomes of combined modality treatment in carefully selected patients. Lung Cancer 2007; 59:385-90. [PMID: 17913281 DOI: 10.1016/j.lungcan.2007.08.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 07/30/2007] [Accepted: 08/24/2007] [Indexed: 12/25/2022]
Abstract
The combination of radiotherapy and concurrent chemotherapy followed by surgery (trimodality treatment) is currently regarded as optimal treatment for non-small cell lung cancer of the superior sulcus (SST) or Pancoast tumour. The possibility to administer intensive combined modality treatment is influenced by tumour stage, comorbidity and performance status of these patients, and therefore a strict patient selection is necessary. This study focuses on patient selection and its results. We retrospectively evaluated choices of treatment and outcome of all patients with SST treated in the Netherlands Cancer Institute from 1994 to 2004. After identification of patients with SST in registration databases, the following characteristics were analyzed: symptoms, comorbidity, tumour stage, treatment characteristics, toxicity, local control, disease-free and overall survival. Fifty-two patients, 37 men and 15 women, were identified. They were diagnosed with stage IIB (27%), stage IIIA (8%), stage IIIB (42%) and stage IV (23%). Twelve patients after induction (chemo)radiotherapy underwent surgical resection. In eight patients a pathologic complete response was found. The 2- and 5-year survival after induction treatment and surgery was 75 and 39%, respectively. Other patients did not receive surgical treatment because of stage IV disease (n=12), comorbidity (n=8), irresectability (extensive tumour growth and/or persisting N2-3 status; n=14) or insufficient response to induction treatment (n=6). Eleven patients were treated with concurrent chemoradiotherapy (5-year survival 20%) and 17 patients with (sequential) radiotherapy and/or chemotherapy (5-year survival 6%). Local recurrence rates were 0% after induction treatment and surgical resection, 32% after concurrent chemoradiotherapy and 72% after (sequential) radiotherapy and/or chemotherapy. In conclusion, only 30% of M0 patients with SST were eligible for combined modality treatment followed by surgery. In this subgroup, concurrent chemoradiotherapy followed by surgery was associated with excellent local control and acceptable survival.
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Affiliation(s)
- I Kappers
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Dartevelle PG, Yildizeli B, Fadel E, Mussot S. MTP19-01: T4 N0/N1 nonsmall cell lung cancer can be cured as a first line treatment with an expected five year survival rate as high as 43% provided a radical resection is performed. J Thorac Oncol 2007. [DOI: 10.1097/01.jto.0000283060.34074.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rusch VW, Giroux DJ, Kraut MJ, Crowley J, Hazuka M, Winton T, Johnson DH, Shulman L, Shepherd F, Deschamps C, Livingston RB, Gandara D. Induction Chemoradiation and Surgical Resection for Superior Sulcus Non–Small-Cell Lung Carcinomas: Long-Term Results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Clin Oncol 2007; 25:313-8. [PMID: 17235046 DOI: 10.1200/jco.2006.08.2826] [Citation(s) in RCA: 260] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTraditional treatment for superior sulcus non–small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC.Patients and MethodsPatients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis.ResultsFrom April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites.ConclusionThis combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.
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Affiliation(s)
- Valerie W Rusch
- Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Chadeyras JB, Mazel C, Grunenwald D. Résection vertébrale monobloc pour cancer pulmonaire : 12 ans d'expérience. ACTA ACUST UNITED AC 2006; 131:616-22. [PMID: 16859631 DOI: 10.1016/j.anchir.2006.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 06/22/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report a single-institution retrospective study of radical en bloc resection for lung cancer invading the spine. METHODS Between 1993 and 2004, 32 patients underwent partial or total vertebrectomy for non-small cells lung cancer with spinal extension. Twenty-one received induction treatment (chemotherapy, N=16; radiation, N=1 and chemoradiotherapy, N=4). Pneumonectomy was performed in 3 patients, lobectomy in 26 patients and wedge resection in 3 patients. Partial vertebrectomy was performed in 26 patients and total vertebrectomy was performed in 6 patients. Tumor stage was IIb in 9 patients, IIIa in 2 patients and IIIb in 21 patients. RESULTS There was no immediate postoperative mortality. Major morbidity was observed in 10 patients (31%), including 4 complications related to spinal surgery. For 28 patients, a completed resection was achieved (87%). 2-years survival was 65% and 5-years survival was 24%. Completed resection and induction chemotherapy appear to be determinant prognostics factors (respectively p=0,01 and p=0,04 in univariate analysis). CONCLUSION Radical en bloc resection with vertebrectomy for lung cancer is technically demanding. Encouraging long-term survival suggest that this surgical approach could be a valid option for selected patients with vertebral involvement of lung cancer.
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Affiliation(s)
- J-B Chadeyras
- Service de Chirurgie Générale à Orientation Thoracique, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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Abstract
Non-small-cell lung carcinomas of the superior sulcus, frequently termed Pancoast tumours, are some of the most challenging thoracic malignant diseases to treat because of their proximity to vital structures at the thoracic inlet. Originally deemed universally fatal, Pancoast tumours are now amenable to curative treatment because of improvements in combined modality therapy and development of new techniques for resection. This review includes discussion of anatomical considerations, initial assessment, multimodality treatment, and surgical approaches for these cancers.
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Affiliation(s)
- Valerie W Rusch
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Munden RF, Swisher SS, Stevens CW, Stewart DJ. Imaging of the Patient with Non–Small Cell Lung Cancer. Radiology 2005; 237:803-18. [PMID: 16251391 DOI: 10.1148/radiol.2373040966] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Lung cancer is the most common type of cancer and is the leading cause of cancer deaths in the United States for both men and women. Even though the 5-year survival rate of patients with lung cancer remains dismal at 14% for all cancer stages, treatments are improving and newer agents for lung cancer appear promising. Therefore, an accurate assessment of the extent of disease is critical to determine whether the patient is treated with surgical resection, radiation therapy, chemotherapy, or a combination of these modalities. Radiologic imaging plays an important role in the staging evaluation of the patient; however, radiologists need to be aware that there are also important differences in what each specialist needs from imaging to provide appropriate treatment. This article reviews the role of imaging in patients with non-small cell lung cancer, with an emphasis on the radiologic imaging findings relevant for each specialty.
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Affiliation(s)
- Reginald F Munden
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Affiliation(s)
- Juan A Garcia
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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