1
|
Issard J, Brioude G, Mitilian D, Fabre D, Thomas de Montpreville V, Hanna A, Caramella C, Lepechoux C, Besse B, Mercier O, Fadel E. Outcomes of right sleeve lower lobectomy vs. lower bilobectomy for lung malignancies. Surg Oncol 2024; 56:102100. [PMID: 39024682 DOI: 10.1016/j.suronc.2024.102100] [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: 02/05/2024] [Revised: 06/09/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES Lower bilobectomy (LBL) leaves a residual pleural space potentially associated with adverse postoperative outcomes. In selected patients, right sleeve lower lobectomy (RSLL) with anastomosis between the middle lobe bronchus and intermediate bronchus is feasible. The outcomes of RSLL and LBL have not been compared. The aim of this study was to compare post-operative and long-term outcomes of RSLL and LBL in patients with lung cancer. METHODS We retrospectively included patients managed by RSLL or LBL at our referral chest-surgery institution between 2001 and 2019. Post-operative complications and mortality were compared. Kaplan-Meier curves were plotted to compare overall and disease-free survival rates. RESULTS We identified 23 patients with RSLL and 96 with LBL. Postoperative mortality was 9 % after RSLL and 5 % after LBL (p = 0.41). Bronchial fistula developed in 3 (13 %) RSLL patients and 6 (6 %) LBL patients (p = 0.23). Pleural space complications were significantly less common after RSLL (4/23 [17 %] vs. 45/96 [47 %], p = 0.03). Long-term vital capacity was significantly higher in the RSLL group (91 % vs. 64 %, p < 0.01). Five-year survival did not differ significantly between groups (84 % vs. 72 %, p = 0.09). CONCLUSIONS RSLL was associated with similar postoperative mortality and long-term survival compared to LBL. However, pleural space complications were less common and lung function was better after RSLL than after LBL. When feasible, RSLL may deserve preference over LBL in patients with lung cancer managed at highly experienced centres.
Collapse
Affiliation(s)
- Justin Issard
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, CHU Hôpital Nord, Marseille, France
| | - Delphine Mitilian
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Dominique Fabre
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Vincent Thomas de Montpreville
- Department of Pathology, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Amir Hanna
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Caroline Caramella
- Department of Radiology, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| | - Cécile Lepechoux
- Department of Radiation Therapy, Gustave Roussy, Université Paris-Saclay, International Center for Thoracic Cancers, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, International Center for Thoracic Cancers, Villejuif, France
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France.
| | - Elie Fadel
- Department of Thoracic Surgery and Heart-lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, International Center for Thoracic Cancers, Le Plessis Robinson, France
| |
Collapse
|
2
|
He Z, Hou J, Li Y, Li Y, Zeng W, Liu W. Analysis of clinical outcomes and prognosis of patients with early bronchogenic lung cancer after treatment of rigid bronchoscopy combining fiberoptic bronchoscopy: a single-center retrospective study. Expert Rev Med Devices 2024; 21:257-263. [PMID: 38131192 DOI: 10.1080/17434440.2023.2298711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To investigate the clinical value of rigid bronchoscopy combined with fiberoptic bronchoscopy in patients with early bronchogenic lung cancer who underwent sleeve lobectomy. METHODS A retrospective study was performed on 76 patients with early bronchogenic lung cancer admitted to our center from March 2016 to March 2017. Patients in the control group received conventional sleeve lobectomy (n = 38), while patients in the observation group underwent sleeve lobectomy by using rigid bronchoscopy combining fiberoptic bronchoscopy (n = 38). We compared perioperative period indicators and the recovery of pulmonary function indexes one month after the operation were compared in two groups. The prognosis of the patients were also analyzed. RESULTS Compared with the control group, the intraoperative blood loss, operation duration and airway reconstruction duration in the observation group were significantly reduced. The total incidence of perioperative complications was markedly lower in the observation group than in the control group. The percentage of DLCO% was significantly improved in the observation group. The relapse-free survival (RFS) in the observation group was remarkably longer than in the control group. CONCLUSION Rigid bronchoscopy combined with fiberoptic bronchoscopy is beneficial to improve the clinical outcome and prognosis of patients with early bronchogenic lung cancer more effectively.
Collapse
Affiliation(s)
- Zhengbing He
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Juhua Hou
- Department of School of Clinical Medicine, Yiyang Medical College, Yiyang, China
| | - Yong Li
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Yu Li
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Wei Zeng
- Department of General Practice, Yiyang Medical College Affiliated Hospital, Yiyang, China
| | - Wenguang Liu
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| |
Collapse
|
3
|
Voltolini L, Viggiano D, Gonfiotti A, Borgianni S, Mugnaini G, Salvicchi A, Bongiolatti S. Complex Sleeve Lobectomy Has Lower Postoperative Major Complications Than Pneumonectomy in Patients with Centrally Located Non-Small-Cell Lung Cancer. Cancers (Basel) 2024; 16:261. [PMID: 38254752 PMCID: PMC10813711 DOI: 10.3390/cancers16020261] [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: 11/15/2023] [Revised: 12/16/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Standard sleeve lobectomies are recommended over pneumonectomy (PN), but the efficacy and oncological proficiency of complex sleeve lobectomies (CSLs) have not been completely investigated. The aim of this study was to report our experience in CSL in patients affected by a centrally located non-small-cell lung cancer (NSCLC), comparing all the variables and outcomes with PN. METHODS From 2014 to 2022, we collected the data of patients who underwent PN and CSL for NSCLC, excluding neuroendocrine tumors, salvage surgery or carinal resection. Regression analysis was used to assess the association between procedures and complications; the Kaplan-Meier method and Cox regression analysis were used to evaluate survival and risk factors of reduced survival. RESULTS We analyzed n = 38 extended sleeve lobectomies and n= 6 double-sleeve lobectomies (CSL group) and n= 60 PNs. We had a trend toward higher postoperative mortality in the PN group (5% vs. 0%, p = 0.13). Major complications and bronchial fistula developed in 21.7% and 6.8% (p = 0.038) and in 6.7% and 4.5% (p = 0.64), respectively. The right side was identified as risk factor for major complications, whereas age > 70 and PN had a trend of association in multivariable analysis. The median OS was similar between the two groups (p = 0.76) and cancer recurrence was the only significant risk factors of reduced OS. Excluding functionally compromised patients, the OS of CSL was better than that of PN (67% vs. 42%, p = 0.25). CONCLUSIONS Considering that major complications are often associated with mortality after surgery for centrally located NSCLC, CSLs could be considered an alternative to PN while also ensuring comparable survival.
Collapse
Affiliation(s)
- Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (L.V.); (G.M.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Domenico Viggiano
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (L.V.); (G.M.)
| | - Alessandro Gonfiotti
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (L.V.); (G.M.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Sara Borgianni
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (L.V.); (G.M.)
| | - Giovanni Mugnaini
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (L.V.); (G.M.)
| | - Alberto Salvicchi
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (L.V.); (G.M.)
| | - Stefano Bongiolatti
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (L.V.); (G.M.)
| |
Collapse
|
4
|
Chen T, Zhong Y, Wen J, Deng J, She Y, Zhu Y, Chen Q, Wu C, Hou L, Jiang L, Chen C. Prognostic Significance of the Proposed Residual Tumor Classification in Patients With NSCLC After Sleeve Lobectomy. JTO Clin Res Rep 2023; 4:100574. [PMID: 37822700 PMCID: PMC10563046 DOI: 10.1016/j.jtocrr.2023.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction To validate the residual tumor (R) classification proposed by the International Association for the Study of Lung Cancer (IASLC) in NSCLC after sleeve lobectomy. Methods A total of 682 patients were analyzed. The R status, on the basis of the Union for International Cancer Control (UICC) criteria, was recategorized according to the IASLC descriptors. Recurrence-free survival (RFS) and overall survival (OS) among different R classifications were assessed for the entire cohort and pathologic node (pN) subgroups. Results All in all, 631 (92.5%), 48 (7.1%), and three patients (0.4%) were classified as R0, R1, and R2, respectively, by the UICC criteria, whereas 489 (71.7%), 110 (16.1%), and 83 patients (12.2%), received R0, uncertain resection (R[un]), and R1/2 resection, respectively, according to the IASLC criteria. There were 96 patients (15.2%) with UICC R0 who were reclassified as R(un), mainly because of the positive highest mediastinal node station (82 of 96, 85.4%). A total of 46 patients (7.3%) were reassigned from UICC R0 to IASLC R1/2 owing to extracapsular extension. For the entire cohort, patients with R(un) and R1/2 exhibited worse RFS (R[un], adjusted p = 0.023; R1/2, adjusted p = 0.001) and OS (R[un], adjusted p = 0.040; R1/2, adjusted p = 0.051) compared with R0. No significant differences were observed between R(un) and R1/2 (RFS, adjusted p = 0.586; OS, adjusted p = 0.781). Furthermore, subgroup analysis revealed a distinct prognostic impact of the IASLC R status-with prognostic significances in the pN1 and pN2 subgroups, but not in the pN0 subgroup. Conclusions The IASLC R descriptors helped to stratify the prognosis of NSCLC after sleeve lobectomy, with its prognostic impact varied among pN stages.
Collapse
Affiliation(s)
- Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jialiang Wen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Qiankun Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Likun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
5
|
Lee JM, Vallières E, Ding B, Johnson A, Bhagwakar J, Rashidi S, Zhu QC, Gitlitz BJ, Weksler B, Costas K, Altorki N. Safety of adjuvant atezolizumab after pneumonectomy/bilobectomy in stage II-IIIA non-small cell lung cancer in the randomized phase III IMpower010 trial. J Thorac Cardiovasc Surg 2023; 166:655-666.e7. [PMID: 36841745 DOI: 10.1016/j.jtcvs.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/12/2022] [Accepted: 01/01/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Adjuvant atezolizumab is a standard of care after chemotherapy in completely resected stage II-IIIA programmed death ligand-1 tumor cell 1% or greater non-small cell lung cancer based on results from the phase III IMpower010 study. We explored the safety and tolerability of adjuvant atezolizumab by surgery type in IMpower010. METHODS Patients had completely resected stage IB-IIIA non-small cell lung cancer (Union Internationale Contre le Cancer/American Joint Committee on Cancer, 7th Ed), received up to four 21-day cycles of cisplatin-based chemotherapy, and were randomized 1:1 to receive atezolizumab 1200 mg every 3 weeks (≤16 cycles or 1 year) or best supportive care. Adverse events and clinical characteristics were investigated by surgery type (pneumonectomy/bilobectomy or lobectomy/sleeve lobectomy) in the randomized stage II-IIIA population who received 1 or more atezolizumab dose or with 1 or more postbaseline assessment (safety evaluable) for best supportive care. RESULTS Overall, 871 patients comprised the safety-evaluable randomized stage II-IIIA population. In the atezolizumab arm, 23% (100/433) received pneumonectomy/bilobectomy and 77% (332/433) received lobectomy/sleeve lobectomy. Atezolizumab discontinuation occurred in 32% (n = 32) and 35% (n = 115) of the pneumonectomy/bilobectomy and lobectomy/sleeve lobectomy groups, respectively. Grade 3/4 adverse events were reported in 21% (n = 21) and 23% (n = 76) of patients in the atezolizumab arms in the pneumonectomy/bilobectomy and lobectomy/sleeve lobectomy groups, respectively. In the atezolizumab arms of the surgery groups, 13% (n = 13) and 17% (n = 55) had an adverse event leading to hospitalization. Atezolizumab-related adverse events leading to hospitalization occurred in 5% (n = 5) and 7% (n = 23) of the surgery groups. CONCLUSIONS These exploratory findings support use of adjuvant atezolizumab after platinum-based chemotherapy in patients with completely resected stage II-IIIA programmed death ligand-1 tumor cell 1% or more non-small cell lung cancer, regardless of surgery type.
Collapse
Affiliation(s)
- Jay M Lee
- Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, Calif.
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Wash
| | - Beiying Ding
- US Medical Affairs and Product Development Clinical Oncology, Genentech Inc, South San Francisco, Calif
| | - Ann Johnson
- US Medical Affairs and Product Development Clinical Oncology, Genentech Inc, South San Francisco, Calif
| | - Jan Bhagwakar
- US Medical Affairs and Product Development Clinical Oncology, Genentech Inc, South San Francisco, Calif
| | - Sanam Rashidi
- Medical and Scientific Affairs, Roche Diagnostics USA, Santa Clara, Calif
| | - Qian Cindy Zhu
- US Medical Affairs and Product Development Clinical Oncology, Genentech Inc, South San Francisco, Calif
| | - Barbara J Gitlitz
- Product Development Clinical Oncology, Genentech Inc, South San Francisco, Calif
| | - Benny Weksler
- Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, Pa
| | - Kimberly Costas
- Division of Thoracic Surgery, Providence Regional Medical Center, Everett, Wash
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| |
Collapse
|
6
|
Ali Bedirhan M. Segmental bronchial sleeve resections. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S40-S44. [PMID: 38344119 PMCID: PMC10852209 DOI: 10.5606/tgkdc.dergisi.2023.24706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2024]
Abstract
In recent years, with the widespread application of bronchial sleeve resection, many studies have shown that, compared to pneumonectomy, bronchial sleeve resections can preserve more lung parenchyma, improve quality of life of patients, and significantly reduce postoperative complications and mortality rates. In this review, we discuss bronchial segmental sleeve resections with variations in the light of literature data.
Collapse
Affiliation(s)
- Mehmet Ali Bedirhan
- Department of Thoracic Surgery, Yedikule Chest and Diseases and Thoracic Surgery Training Research Hospital, Istanbul, Türkiye
| |
Collapse
|
7
|
Chen T, Zhao W, Ji C, Luo J, Wang Y, Liu Y, Weder W, Fang W. Minimally invasive sleeve lobectomy for centrally located lung cancer: A real-world study with propensity-score matching. Front Oncol 2023; 13:1099514. [PMID: 36816921 PMCID: PMC9929062 DOI: 10.3389/fonc.2023.1099514] [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: 11/15/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
Background The safety, feasibility, and prognosis of sleeve lobectomy by minimally invasive surgery (MIS) remain to be validated. The purpose of this study was to investigate outcomes in real-world patients receiving minimally invasive sleeve lobectomy in a balanced large cohort. Methods Between January 2013 and December 2018, 578 consecutive patients undergoing sleeve resection at a high-volume center were retrospectively analyzed. Surgical and oncologic outcomes were compared between MIS and thoracotomy patients after propensity-score matching (PSM). Results MIS sleeve lobectomy was increasingly used as a time-trend in real-world. Before PSM, the MIS group had smaller tumor size, more T2-stage cases, and more right upper lobe sleeve lobectomies compared to the Open group. After 1:4 PSM by patient demographics and tumoral characteristics, 100 cases of MIS and 338 cases of Open sleeve lobectomy were further analyzed. Although median operation time was longer in the MIS group than in the Open group (170.5 minutes vs.149.5 minutes, P < 0.001), patients in MIS group had significantly less estimated intraoperative blood loss (100 ml vs. 200 ml, P = 0.003), shorter drainage duration (5 days vs. 6 days, P = 0.027) and less amount of drainage (1280 ml vs. 1640 ml, P < 0.001) after surgery. Complete resection rate, combined angioplasty, number of dissected lymph nodes, post-operative length of stay, postoperative morbidity and mortality rate, and application of adjuvant therapy were similar between the two matched groups. Conversion to open thoracotomy was necessary in 13.6% patients, but with similar perioperative outcomes compared to Open cases except for longer operation time. More lower lobe sleeve lobectomies were accomplished via robot-assisted thoracoscopic surgery than via video-assisted thoracoscopic surgery (40.0% vs. 12.0%, P = 0.017) in MIS patients. Five-year overall survivals (MIS vs. Open: 72.7% vs. 64.4%, P = 0.156) and five-year progression-free survivals (MIS vs. Open: 49.2% vs. 50.5%, P = 0.605) were similar between the two matched groups. Conclusions MIS sleeve lobectomy is associated with similar or even better perioperative results and oncologic outcomes to open thoracotomy. Conversion to thoracotomy does not compromise perioperative outcomes. Robot surgery may be preferable for more complex sleeve resections.
Collapse
Affiliation(s)
- Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weigang Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s Hospital, Shanghai, China
| | - Chunyu Ji
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jizhuang Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Liu
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Wentao Fang,
| |
Collapse
|
8
|
Menna C, Rendina EA, D’Andrilli A. Parenchymal Sparing Surgery for Lung Cancer: Focus on Pulmonary Artery Reconstruction. Cancers (Basel) 2022; 14:cancers14194782. [PMID: 36230705 PMCID: PMC9563968 DOI: 10.3390/cancers14194782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Reconstruction of the pulmonary artery (PA) associated with lobectomy for the radical resection of lung cancer has been progressively gaining diffusion in lung cancer surgery as a safe and effective therapeutic option that may allow radical resection when lobectomy is not technically feasible, avoiding pneumonectomy. There are some controversial aspects concerning the intraoperative and perioperative management of a sleeve resection with PA reconstruction that may influence the outcome. In the present article, the authors have analyzed some of the main technical and oncological aspects to take stock of what they have learned from their lung-sparing operations experience over time. PA reconstruction may require prosthetic materials including different options with variable cost. A main concern in vascular reconstructive procedures is avoiding tension on the anastomosis. When PA reconstruction is required, appropriate anticoagulation management is crucial. Results from the main literature data confirm the reliability of lobectomy associated with PA reconstruction in terms of perioperative morbidity and long-term survival. Sleeve lobectomy and PA reconstruction can be performed safely and effectively even after induction therapy.
Collapse
Affiliation(s)
- Cecilia Menna
- Correspondence: ; Tel.: +39-(0)6-3377-5155; Fax: +39-(0)6-3377-5578
| | | | | |
Collapse
|
9
|
Wang L, Ge L, Zhang G, Wang Z, Liu Y, Ren Y. Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study. Front Surg 2022; 9:948026. [PMID: 36017516 PMCID: PMC9395916 DOI: 10.3389/fsurg.2022.948026] [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: 05/19/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrognostic factors in a pneumonectomy (PN) are not yet fully defined. This study sought to analyze and evaluate long-term survival after pneumonectomies (PNs) for patients with non-small cell lung cancer (NSCLC).MethodsWe obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent PNs between 2004 and 2015. Propensity score matching (PSM) analysis and Kaplan–Meier curves were used to estimate overall survival (OS), while univariate and multivariable Cox proportional hazards regression analyses were applied to create a forest plot.ResultsIn total, 1,376 patients were grouped according to right/left PNs. Before matching, OS was worse after a right PN [hazard ratio (HR): 1.459; 95% CI 1.254–1.697; P < 0.001] and after matching, survival differences between groups were not significant (HR: 1.060; 95% CI 0.906–1.240; P = 0.465). Regression analysis revealed that age, gender, grade, lymph node dissection, N-stage, and chemotherapy were independent predictors of OS (P < 0.05). Chemotherapy was associated with improved OS (P < 0.001).ConclusionsLaterality was not a significant prognostic factor for long-term survival after a PN for NSCLC. Chemotherapy was a significant independent predictor of improved OS. Long-term survival and outcomes analyses should be conducted on larger numbers of patients.
Collapse
Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guofeng Zhang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Ziyi Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, Shenyang, China
- Correspondence: Yi Ren
| |
Collapse
|
10
|
Kuckelman J, Debarros M, Bueno R. Extended Resections for Lung Cancer. Surg Clin North Am 2022; 102:345-363. [DOI: 10.1016/j.suc.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
11
|
Liu C, Yang Z, Guo C, Zhu Y, Pu Q, Mei J, Ma L, Lin F, Liu L. Lobectomy with pulmonary artery angioplasty for lung cancer using video-assisted thoracic surgery versus open thoracotomy: a retrospective propensity matched analysis. Transl Lung Cancer Res 2021; 10:3943-3956. [PMID: 34858783 PMCID: PMC8577973 DOI: 10.21037/tlcr-21-607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/26/2021] [Indexed: 02/05/2023]
Abstract
Background Pulmonary artery angioplasty (PAA) is an important surgical procedure to complete radical resection with maximum preservation of functioning pulmonary tissues when the pulmonary artery is involved. In this study, we aimed to evaluate the short- and long-term outcomes of PAA using video-assisted thoracic surgery (VATS) versus open thoracotomy (OT) in lung cancer surgery. Methods We retrospectively reviewed 214 patients who underwent PAA between November 2005 and October 2016. Propensity score matching (PSM) was applied to reduce confounding effects. The survival outcomes were assessed using Kaplan-Meier estimates and Cox regression analysis. Results The final sample included 203 patients (28 patients in the VATS group and 175 patients in the OT group). There were no differences between the two groups in operative time, blood loss, duration of chest tube drainage, postoperative hospital stays, margin status, postoperative morbidity and mortality, and number of N1 and N2 stations or number of N1 and N2 lymph nodes both before and after matching. At a median follow-up period of 43 (range, 6 to 158) months, the 5-year overall survival (OS) and recurrence-free survival (RFS) of the overall cohort were 47.9% and 42.1%, respectively. The 5-year OS and RFS were comparable between the VATS and OT groups both in the overall cohort and the matched cohort. The VATS procedure was found not to have a prognostic impact on either OS (hazard ratio, 1.17; 95% CI: 0.60 to 2.30, P=0.647) or RFS (hazard ratio, 1.14; 95% CI: 0.62 to 2.10, P=0.666). Conclusions VATS PAA is associated with comparable short- and long-term outcomes in selected patients with lung cancer compared with OT.
Collapse
Affiliation(s)
- Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Zhenyu Yang
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yunke Zhu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| |
Collapse
|
12
|
Chriqui LE, Forster C, Lovis A, Bouchaab H, Krueger T, Perentes JY, Gonzalez M. Is sleeve lobectomy safe after induction therapy?-a systematic review and meta-analysis. J Thorac Dis 2021; 13:5887-5898. [PMID: 34795937 PMCID: PMC8575812 DOI: 10.21037/jtd-21-939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
Background Sleeve lobectomy (SL) is a lung-sparing procedure, which is accepted as a valid operation for centrally-located advanced tumors. These tumors often require induction treatment by chemotherapy and/or radiotherapy to downstage the disease and thus facilitate subsequent surgery. However, induction therapy may potentially increase the risk of bronchial anastomotic complications and related morbidity. This meta-analysis aims to determine the impact of induction therapy on the outcomes of pulmonary SL. Methods We compared studies of patients undergoing SL or bilobectomy for non-small cell lung cancer (NSCLC) with and without induction therapy. Outcomes of interest were in-hospital mortality, morbidity, anastomosis complication and 5-year survival. Odds ratio (OR) were computed following the Mantel-Haenszel method. Results Ten studies were included for a total of 1,204 patients. There was no statistical difference for between patients who underwent induction therapy followed by surgery and patients who underwent surgery alone in term of post-operative mortality (OR: 1.80, 95% confidence interval (CI): 0.76-4.25, P value =0.19) and morbidity (OR: 1.17, 95% CI: 0.90-1.52, P value =0.237). Anastomosis related complications rate were 5.2% and appears increased after induction therapy with a statistical difference close to the significance (OR: 1.65, 95% CI: 0.97-2.83, P value =0.06). Patients undergoing surgery alone showed better survival at 5 years (OR: 1.52, 95% CI: 1.15-2.00, P value =0.003). Conclusions SL following induction therapy can be safely performed with no increase of mortality and morbidity. However, the need for induction therapy before surgery is associated with increased anastomotic complications and poorer survival prognosis at 5 years.
Collapse
Affiliation(s)
- Louis-Emmanuel Chriqui
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Alban Lovis
- Service of Pneumology. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Hasna Bouchaab
- Service of Oncology University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery. University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
13
|
Sayan M, Kankoc A, Ozkan D, Celik A, Kurul IC, Tastepe AI. Prognostic Analysis of Primary Pulmonary Malignant Mesenchymal Tumors Treated Surgically. J Chest Surg 2021; 54:356-360. [PMID: 34376628 PMCID: PMC8548186 DOI: 10.5090/jcs.21.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/31/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Primary pulmonary malignant mesenchymal tumors are rare, constituting only 0.4% of all lung cancers. Since sarcomas are chemo/radio-resistant, surgical resection is the optimal treatment choice for patients with suitable medical conditions and tumor stage. In the present study, we analyzed the surgical outcomes and survival of primary pulmonary malignant mesenchymal tumors treated surgically. Methods We retrospectively examined the records of patients with primary pulmonary malignant mesenchymal tumors who underwent surgical resection at our department between January 2010 and December 2020. Patient data were analyzed according to age, sex, tumor grade and stage, resection completeness, surgical type, and tumor histopathology. Results Twenty patients were included in the study. There were 13 men (65%) and 7 women (35%). The median survival rate was 36 months (range, 19–53 months), and the 5-year overall survival rate was 37%. Unfavorable prognostic factors for overall survival included parietal pleural invasion (p=0.02), high tumor grade (p=0.02), advanced tumor stage (p=0.02), and extensive parenchymal resection (pneumonectomy and bilobectomy, p=0.01). The median length of disease-free survival was 31 months (interquartile range, 21–41 months), and the 5-year disease-free survival rate was 32%. The most unfavorable prognostic factors for recurrence were parietal pleural invasion (p=0.02), high tumor grade (p=0.01), and tumors requiring lung resection with chest wall resection (p=0.02). Conclusion Primary malignant mesenchymal lung tumors are aggressive and have a high mortality rate. However, acceptable overall and disease-free survival rates can be obtained with surgical therapy.
Collapse
Affiliation(s)
- Muhammet Sayan
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Aykut Kankoc
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Dilvin Ozkan
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Celik
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ismail Cuneyt Kurul
- Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | |
Collapse
|
14
|
Inci I, Benker M, Çitak N, Schneiter D, Caviezel C, Hillinger S, Opitz I, Weder W. Complex sleeve lobectomy has the same surgical outcome when compared with conventional lobectomy in patients with lung cancer. Eur J Cardiothorac Surg 2021; 57:860-866. [PMID: 31919516 DOI: 10.1093/ejcts/ezz357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES No significant data are available to assess whether complex sleeve lobectomy (complex-SL) can be considered comparable to conventional lobectomy (CL) in terms of surgical outcome. The purpose of this study was to compare surgical and oncological outcomes of complex-SL with CL in patients with lung cancer. METHODS Between 2000 and 2015, a total of 568 patients who underwent open CL (defined as resection of only 1 lobe) and 187 patients who underwent SL were analysed. The SL group was divided into 2 subgroups: standard-SL (bronchial SL, n = 106) and complex-SL (n = 81) (defined as bronchial sleeve resection together with another surgical intervention: bronchovascular SL, n = 40; vascular SL, n = 26; atypical bronchoplasty with resection of more than 1 lobe, n = 12; bronchial SL + chest wall resection, n = 3). RESULTS The complex-SL group had more patients with chronic obstructive pulmonary disease (COPD) (25.9% vs 12.5%, P = 0.001), neoadjuvant treatment (39.5% vs 12.0%, P < 0.001), advanced-stage non-small-cell lung cancer (53.2% vs 33.1%, P = 0.001) and low preoperative forced expiratory volume in 1 s (77.2% vs 84.3%, P = 0.004) than the CL group. The overall surgical mortality (in-hospital or 30-day) was 2.6% (n = 20); it was 2.8% for CL and 2.8% for complex-SL. Postoperative complications occurred in 34.9% of the CL group and 39.5% of the complex-SL group (P = 0.413). The pulmonary complication rate was similar between the groups (24.1% for CL, 27.2% for complex-SL, P = 0.552). The 5-year survival in the CL group was 57.1%, and in the complex-SL group it was 56.2% (P = 0.888). Multivariate analysis showed that TNM stage (P < 0.001) and N status (P < 0.001) were significant and independent negative prognostic factors for survival. CONCLUSIONS Complex-SL had a comparable outcome to CL, although the complex-SL group had more patients with advanced-stage NSCLC, low preoperative forced expiratory volume in 1 s and COPD.
Collapse
Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martina Benker
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Necati Çitak
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, Bakırköy Dr. Sadi Konuk Research and Education Hospital, Istanbul, Turkey
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
15
|
Yang M, Zhong Y, Deng J, She Y, Zhang L, Wang Y, Zhao M, Hu X, Xie D, Chen C. Comparison of Bronchial Sleeve Lobectomy with Pulmonary Arterioplasty versus Pneumonectomy. Ann Thorac Surg 2021; 113:934-941. [PMID: 33872578 DOI: 10.1016/j.athoracsur.2021.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the efficacy of bronchial sleeve lobectomy with pulmonary arterioplasty by comparing to pneumonectomy in centrally located non-small cell lung cancer (NSCLC) with bronchovascular invasion. METHODS The entire cohort consisted of 212 patients receiving pneumonectomy and 156 patients undergoing bronchial sleeve lobectomy with pulmonary arterioplasty. Propensity score matching was adopted to create a fully balanced cohort, after which, baseline characteristics, perioperative performance and oncological results were compared between two groups. RESULTS Totally 139 pneumonectomy cases were matched with 139 sleeve lobectomy cases. In the matched cohort, bronchial sleeve lobectomy with pulmonary arterioplasty was associated with longer operative time (p<0.001), decreased perioperative transfusion rate (p=0.002), shorter postoperative hospital stays (p<0.001), shorter intensive care unit stays (p=0.040) and lower Clavien-dindo Classification (p=0.016). In respect to survival outcomes, Log-rank test revealed no significant difference in OS (p= 0.381) and RFS (p=0.619) between two surgical procedures. CONCLUSIONS Bronchial sleeve lobectomy with pulmonary arterioplasty could achieve superior perioperative outcomes and equivalent oncological efficacy in comparison with pneumonectomy, indicating that this complex procedure is safe and reliable for centrally located NSCLC concurrently involving the pulmonary artery and bronchus.
Collapse
Affiliation(s)
- Minglei Yang
- Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Yang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University.
| |
Collapse
|
16
|
SHIMIZU J, MORIYA M, KAMESUI T, NAGAYOSHI T, NONOMURA A, ARANO Y, SHINAGAWA S. Successful left pneumonectomy in a case of giant-sized squamous cell carcinoma of the lung after having difficulty in determining resectability. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
17
|
Li Z, Xia M, Liu C, Wang T, Ren Y, Liu Y. A meta-analysis of minimally invasive surgery versus thoracotomy for centrally located non-small cell lung cancer. J Thorac Dis 2021; 13:252-261. [PMID: 33569205 PMCID: PMC7867798 DOI: 10.21037/jtd-20-3273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Surgery is established as the most effective treatment for central lung cancer. Minimally invasive surgery (MIS) is gaining popularity. The decision of whether surgical treatment of central lung cancer should be minimally invasive or a conventional thoracotomy is a critical decision for the thoracic surgeon. However, whether MIS is more advantageous than other surgical treatments for central lung cancer. This study aimed to compare the short- and long-term results of MIS and conventional thoracotomy in patients with central lung cancer. Methods This meta-analysis was conducted using the PubMed, Embase, Wiley Online Library, Google Scholar, Wanfang, and China National Knowledge Infrastructure databases. Searches for relevant studies were conducted in strict accordance with research protocols detailed in the Cochrane handbook. The primary endpoints for comparison between the two surgical methods were perioperative and long-term survival. A 95% confidence interval (CI) for relative risk (RR)/mean difference (MD) was calculated to assess the strength of the correlation. Results Nine studies that met the inclusion and exclusion criteria were eventually included in this meta-analysis. These studies involved a total of 5,869 patients [MIS, n =1,140 versus thoracotomy (TH), n =4,729]. The 3- and 5-year disease-free survival (DFS) and the 2-, 3-, and 5-year overall survival (OS) were similar for the MIS and TH groups [OR: 0.86 (95% CI: 0.51–1.43); P=0.55; OR: 1.01 (95% CI: 0.43–2.36); P=0.99, OR: 0.91 (95% CI: 0.78–1.05); P=0.18; OR: 0.90 (95% CI: 0.77–1.06); P=0.22; OR: 0.95 (95% CI: 0.25–1.53); P=0.30]. A subgroup analysis of 8 articles revealed no statistical difference in the pathological type of non-small cell lung cancer (squamous cell carcinoma or adenocarcinoma) between the two groups [OR: 0.99 (95% CI: 0.89–1.09); P =0.81]. However, the MIS group had a lower incidence of blood loss, duration of hospital stay, and fewer complications [MD: −46.25 (95% CI: −85.05 to −7.46); P=0.02; MD: −1.93 (95% CI: −3.15 to −0.7); P=0.002; MD: 0.73 (95% CI: 0.61–0.88); P=0.001]. Conclusions MIS was shown to be a more effective option to conventional thoracotomy for the treatment of central lung cancer.
Collapse
Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Mozhu Xia
- Department of Operation Room, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Chang Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Tao Wang
- Department of Anesthesia, Shenyang Chest Hospital, Shenyang, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| |
Collapse
|
18
|
Zhang C, Yu Z, Li J, Zu P, Yu P, Wang G, Miyazaki T, Waseda R, Caso R, Maurizi G, Liu H. Hybrid video-assisted thoracoscopic surgery sleeve lobectomy for non-small cell lung cancer: a case report. J Thorac Dis 2020; 12:6836-6846. [PMID: 33282385 PMCID: PMC7711411 DOI: 10.21037/jtd-20-2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chenlei Zhang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Jijia Li
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Peng Zu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Pingwen Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Gebang Wang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Raul Caso
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| |
Collapse
|
19
|
莫 益, 林 丽, 李 志, 钟 承, 颜 峻, 况 军, 杨 国, 张 建. [Efficacy of Lung Autotransplantation for Central Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:673-678. [PMID: 32838489 PMCID: PMC7467987 DOI: 10.3779/j.issn.1009-3419.2020.103.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/29/2020] [Accepted: 06/23/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pneumonectomy and sleeve resection are routine operations for the treatment of central non-small cell lung cancer (NSCLC), but some patients suffered of central NSCLC, whose pulmonary function is too poor to tolerate pneumonectomy, or the tumor involves the bronchus and pulmonary artery extensively,it is hard to perform bronchovascular sleeve lobectomy. The aim of this study is to assess the feasibility of lung autotransplantation in the treatment of central NSCLC. METHODS The clinical data of 3 cases with central NSCLC treated by lung autotransplantation was reviewed from December 2016 to December 2018. One patient underwent double sleeve resection of left upper lobe with end-to-end anastomosis of the bronchus. Because the resection of the pulmonary artery was too long to perfrom a tension-free anastomosis, the inferior pulmonary vein was cut off, then the left lower lobe was moved up for an anastomosis of the inferior pulmonary vein and the stump of the superior pulmonary vein. In the other 2 cases, left pneumonectomy was performed directly, and the upper left lobe was excised in vitro. The lower left lobe was reset to the chest after trimming and flushing and then the bronchus, pulmonary artery and pulmonary vein were anastomosed in turn. RESULTS The average operation time was 333 min, the average time of vascular occlusion was 86 min, the average blood loss was 450 mL, and the average hospital stay was 18.7 d; Perioperative complications included a case of bronchial obstruction, which improved after sputum aspiration through bronchofibroscope. The average follow-up period was 20 mon; One case died of cancer, one case had recurrence of anastomotic stoma and brain metastasis, one case had 4R lymph node metastasis (stable condition after chemotherapy), and one case survived without recurrence. CONCLUSIONS For patients with central NSCLC with extensive tumor invasion, thus inability to tolerate sleeve resection or pneumonectomy, autologous lung transplantation can preserve lung function to the greatest extent with a complete tumor resection and improve postoperative quality of life.
Collapse
Affiliation(s)
- 益俊 莫
- 518101 深圳, 南方医科大学深圳医院胸外科, 医学影像中心Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
| | - 丽娜 林
- 510520 广州, 中山大学新华学院护理学院School of Nursing, Xinhua College of Sun Yat-Sen University, Guangzhou 510520, China
| | - 志新 李
- 200433 上海, 同济大学附属上海市肺科医院胸外科Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - 承华 钟
- 518101 深圳, 南方医科大学深圳医院胸外科, 医学影像中心Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
| | - 峻 颜
- 518101 深圳, 南方医科大学深圳医院胸外科, 医学影像中心Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
| | - 军 况
- 518101 深圳, 南方医科大学深圳医院胸外科, 医学影像中心Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
| | - 国雄 杨
- 518101 深圳, 南方医科大学深圳医院胸外科, 医学影像中心Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
| | - 建华 张
- 518101 深圳, 南方医科大学深圳医院胸外科, 医学影像中心Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
| |
Collapse
|
20
|
Chen J, Soultanis KM, Sun F, Gonzalez-Rivas D, Duan L, Wu L, Jiang L, Zhu Y, Jiang G. Outcomes of sleeve lobectomy versus pneumonectomy: A propensity score-matched study. J Thorac Cardiovasc Surg 2020; 162:1619-1628.e4. [PMID: 32919775 DOI: 10.1016/j.jtcvs.2020.08.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/09/2020] [Accepted: 05/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare short- and long-term outcomes between sleeve lobectomy and pneumonectomy for lung cancer in a single center during a 15-year period. METHODS One thousand nine hundred eighty-one patients who underwent either a sleeve lobectomy (n = 964; 48.7%) or a pneumonectomy (n = 1017; 51.3%) from January 2003 to December 2017 at the Shanghai Pulmonary Hospital, were matched according to a propensity score to produce 2 groups of 665 patients each. The study period was divided into 3 5-year subperiods. RESULTS Sleeve lobectomy was associated with a lower 30- and 90-day mortality (0.60% and 0.90% vs 1.5% and 3.91%; P = .177 and P = .001, respectively, after matching), lower morbidity (4.36% vs 8.16%; P = .005 before matching, 3.61% vs 8.72%; P < .001 after matching), improved 5-year survival (62.7% vs 43.1%; P < .001 before matching and 61% vs 44.7%; P < .001 after matching), and 5-year disease-free survival after matching (56.6% vs 46.2%; P < .001). The sleeve lobectomy to pneumonectomy ratio increased by 78%, whereas 90-day mortality decreased by 66.81% between the first and the last subperiods. CONCLUSIONS Sleeve lobectomy is associated with improved short- and long-term outcomes and should be the resection of choice for centrally located lung cancers, when feasible.
Collapse
Affiliation(s)
- Jian Chen
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | | | - Fenghuan Sun
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Liang Duan
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Liang Wu
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Lei Jiang
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Yuming Zhu
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Gening Jiang
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China.
| |
Collapse
|
21
|
Voltolini L, Gonfiotti A, Viggiano D, Borgianni S, Farronato A, Bongiolatti S. Extended sleeve-lobectomy for centrally located locally advanced non-small cell lung cancer is a feasible approach to avoid pneumonectomy. J Thorac Dis 2020; 12:4090-4098. [PMID: 32944320 PMCID: PMC7475556 DOI: 10.21037/jtd-20-1241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Backgrounds The aim of this study was to report our Institutional experience with extended sleeve lobectomy (ESL) in centrally located non-small cell lung cancer (NSCLC), focusing on technical details, post-operative results, recurrence and survival, to determine whether ESL can be accepted as a favorable alternative procedure to pneumonectomy (PN). Methods Twenty-two consecutive patients undergoing ESL for centrally located tumors from January 2014 to June 2019 were prospectively enrolled. Results Six (27.3%) patients had been preoperatively considered unfit for PN. Neo-adjuvant chemotherapy was administered in 7 (31.8%) out of the 10 patients that showed a cN2 disease. According to Okada classification, 8 cases of type A ESL (resection of right upper plus middle lobe ± segment 6), one case of type B (resection of left upper lobe + segment 6) and 13 cases of type C (resection of left lower lobe + lingulectomy) ESL were performed. Concomitant pulmonary angioplasty was done in 7 (31.8%) patients. Complete resection was achieved in all patients. There was no postoperative mortality. Major postoperative complications developed in 2 (9.1%) patients (one small anastomotic dehiscence healed in few weeks, one pulmonary embolism). Complete long-term patency of the reconstructed airway was documented in all patients by fiber-optic bronchoscopy. At the median follow-up of 21 months (4–57 months), the recurrence rate was 54.5%, with 4 (18.2%) patients developing a loco-regional recurrence but no endobronchial or perianastomotic recurrence occurred. The overall 3-year survival rate was 45% with a median survival of 33 months. Conclusions ESL is a safe and effective procedure that should be considered a favorable alternative to PN whenever it may guarantee a complete resection.
Collapse
Affiliation(s)
- Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | | | | | - Sara Borgianni
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | | | | |
Collapse
|
22
|
Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
Collapse
Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
| |
Collapse
|
23
|
Xie D, Deng J, Gonzalez-Rivas D, Zhu Y, Jiang L, Jiang G, Chen C. Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non-small cell lung cancer. J Thorac Cardiovasc Surg 2020; 161:403-413.e2. [PMID: 32386762 DOI: 10.1016/j.jtcvs.2020.01.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 12/31/2019] [Accepted: 01/31/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the adequacy of bronchial sleeve lobectomy by video-assisted thoracoscopic surgery in perioperative outcomes and its oncological efficacy by comparing with thoracotomy in a balanced population. METHODS A total of 363 patients who received bronchial sleeve lobectomy for non-small cell lung cancer from January 2013 to December 2017 were included and placed in the thoracotomy (n = 251) and video-assisted thoracoscopic surgery (n = 112) groups. Statistical analyses were performed to compare patients' demographics, perioperative outcomes, and survival between the 2 groups. RESULTS A total of 116 thoracotomy cases were matched with 72 video-assisted thoracoscopic surgery cases by propensity score. Compared with thoracotomy, patients in the video-assisted thoracoscopic surgery group after matching had less intraoperative blood loss (P < .01) and length of postoperative hospital stay (P < .01), duration of chest tube drainage (P < .01), and intensive care unit stay (P = .03) despite comparable operative time, complication rate, and 30- to 90-day mortality rate. The overall survival and recurrence-free survival were similar in patients who received sleeve lobectomy by thoracotomy and video-assisted thoracoscopic surgery (log-rank, P = .24 and .20, respectively) at 3 years. Although advanced TNM stage was independently associated with worse overall survival and recurrence-free survival in multivariable analysis, older age was only predictive for worse overall survival (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .02). Body mass index was also found be a predictive factor (overall survival: hazard ratio, 0.93; 95% confidence interval, 0.86-0.99, P = .03; recurrence-free survival: hazard ratio, 0.93; 95% confidence interval, 0.87-0.99, P = .02). CONCLUSIONS With appropriate patient selection and continued experience, video-assisted thoracoscopic surgery appears to be safe in the short-term perioperative period and does not appear to comprise oncologic outcomes in performing sleeve lobectomy.
Collapse
Affiliation(s)
- Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
| |
Collapse
|
24
|
Qu R, Ping W, Hao Z, Cai Y, Zhang N, Fu X. Surgical outcomes of segmental bronchial sleeve resection in central non-small cell lung cancer. Thorac Cancer 2020; 11:1319-1325. [PMID: 32198981 PMCID: PMC7180578 DOI: 10.1111/1759-7714.13403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study was to present the clinical and surgical results in patients who underwent segmental bronchial sleeve reconstruction. Methods The clinical and pathological data of 16 patients with central non‐small cell lung cancer (NSCLC) who underwent segmental bronchial sleeve resection from April 2015 to May 2019 were retrospectively analyzed. Results According to the type of segmental bronchial reconstruction, procedures were divided into four types: right upper S6 sleeve lobectomy in three cases (type A); left lower lingular sleeve lobectomy in 10 cases (type B); left upper S6 sleeve lobectomy in two cases (type C); and left lower propriolateral superior sleeve lobectomy in one case (type D). A total of three patients (18.75%) experienced anastomotic complications, including two with anastomotic stenosis and one with anastomotic fistula. All patients achieved R0 resection. Apart from one patient who died of acute lung infection after surgery, the rest were successfully discharged. The average follow‐up time was 28 months, and the overall survival rates of patients at one, two, and three years were 80.0%, 53.3%, and 40.0%, respectively. Conclusions Segmental bronchial sleeve resection is complex in technique and may have an increased risk of complications compared to a standard sleeve resection, but it is an effective and safe procedure, especially for selected patients with central lung cancer.
Collapse
Affiliation(s)
- Rirong Qu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ping
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhipeng Hao
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yixin Cai
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | |
Collapse
|
25
|
Hong TH, Kim J, Shin S, Kim HK, Choi YS, Zo JI, Shim YM, Cho JH. Clinical outcomes of microscopic residual disease after bronchial sleeve resection for non-small cell lung cancer. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30518-3. [PMID: 32249083 DOI: 10.1016/j.jtcvs.2020.02.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/06/2020] [Accepted: 02/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the significance of microscopic residual disease (MRD) at the bronchial resection margin after bronchial sleeve resection in non-small cell lung cancer. METHODS We retrospectively reviewed 536 consecutive patients who underwent bronchial sleeve resection between 1995 and 2015. Clinical outcomes, including recurrence and long-term survival, were analyzed according to the bronchial resection margin status (R0 = complete resection and R1 = microscopic residual tumor). RESULTS Forty patients (7.5%) were identified to have MRD. During a 52.4-month follow-up (range, 0.1-261.0 months), there was no significant difference in 5-year overall survival (61.8% vs 61.5%; P = .550) and 5-year recurrence-free survival (53.7% vs 59.0%; P = .390) between groups R1 and R0. Multivariable cox regression analysis demonstrated that the margin status (group R1) was not associated with significantly decreased overall survival and recurrence-free survival. In group R1, 3 patients (7.5%) showed locoregional recurrence, including 1 patient (2.5%) with anastomotic recurrence. There were no significant differences between both groups in anastomotic recurrence (2.5% vs 2.6%; P = 1.000), locoregional recurrence (7.5% vs 12.7%; P = .476), and distant recurrence (25.0% vs 23.2%; P = .947) rates. Subgroup analysis of group R1 revealed a significant trend toward an increasing recurrence rate as the pathological extent of MRD advanced toward invasive extramucosal carcinoma (P for trend = .015). CONCLUSIONS In our experience of bronchial sleeve resection, the oncologic outcome of MRD was not jeopardized. Furthermore, the pathological extent of MRD might be helpful for recurrence prediction and treatment planning.
Collapse
Affiliation(s)
- Tae Hee Hong
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
| |
Collapse
|
26
|
Li Z, Chen W, Xia M, Liu H, Liu Y, Inci I, Davoli F, Waseda R, Filosso PL, White A. Sleeve lobectomy compared with pneumonectomy for operable centrally located non-small cell lung cancer: a meta-analysis. Transl Lung Cancer Res 2019; 8:775-786. [PMID: 32010556 DOI: 10.21037/tlcr.2019.10.11] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The purpose of this meta-analysis was to evaluate evidence comparing sleeve lobectomy (SL) and pneumonectomy (PN) in the treatment of non-small cell lung cancer (NSCLC). Methods The English literature search was undertaken in January 2018 and included studies dating back to 1996. Comparative studies were identified, evaluating survival, local recurrence, and distant recurrence rates, operative mortality, 30-day mortality, as well as complications. A pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated with either the random or fixed-effect model. Results A total of 27 studies were identified, with publication dates between 1996 and 2018. These 27 studies included a total of 14,194 patients: 4,145 treated with SL and 10,049 treated with PN. The overall survival was significantly higher in the SL group compared to the PN one at 1, 3, 5 years. In patients with N0 and N1 disease, 5-year survival rates following SL exceeded those following PN. There was no statistically significant difference in the 3-, 5-year overall survival of N2 patients, according to the extent of surgery. The PN group had a higher rate of operative mortality, 30-day mortality and distant recurrence incidence. However, no statistical difference in complications and local recurrence between SL and PN were observed. Conclusions SL is an effective treatment option for hilar NSCLC with improved long-term survival compared to PN, with no increase of recurrence rate or postoperative complications. Furthermore, N2 disease is an important factor related to survival, and lymph node downstaging is a favorable prognostic factor.
Collapse
Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang 110044, China
| | - Wei Chen
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang 110042, China
| | - Mozhu Xia
- Department of Thoracic Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang 110042, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang 110044, China
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabio Davoli
- Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy
| | - Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Pier Luigi Filosso
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Abby White
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
27
|
Cohen C, Pop D, Benkirane T, Mouroux J, Berthet JP. Upper lobe preservation in the treatment of centrally located NSCLC: one more challenge in lung-sparing surgery? J Thorac Dis 2019; 10:6418-6422. [PMID: 30746179 DOI: 10.21037/jtd.2018.11.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Charlotte Cohen
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
| | - Daniel Pop
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
| | - Taib Benkirane
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
| | - Jérôme Mouroux
- Department of Thoracic Surgery, University Hospital of Nice, Nice, France
| | | |
Collapse
|
28
|
Pneumonectomy after induction chemoradiotherapy for locally advanced non-small cell lung cancer: should curative intent pulmonary resection be avoided? Surg Today 2019; 49:197-205. [PMID: 30610361 DOI: 10.1007/s00595-018-1751-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/27/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE We conducted a retrospective analysis to assess the practicality of pneumonectomy, especially after concurrent induction chemoradiotherapy (i-CRT), for locally advanced non-small cell lung cancer (LA-NSCLC). The operative risks vs. the survival benefit of this procedure for such patients is a subject of controversy. METHODS The subjects of this retrospective study were 71 consecutive LA-NSCLC patients with cStage IIIA-C NSCLC, who underwent i-CRT followed by curative intent pulmonary resection between February, 2001 and March, 2013. RESULTS Thirty-two patients underwent pneumonectomy (group P) and 39 patients underwent lobectomy (group L). In group P, 17 (54.8%) patients underwent right pneumonectomy. There was no 30-day postoperative mortality in either group and no significant difference in 90-day postoperative mortality between the groups (3.1% vs. 2.6% in groups P and L, respectively). The 5-year overall survival (OS) rate was 58.7% (95% CI: 41.5-75.9%) in group P and 57.3% (95% CI 41.2-73.4%) in group L, without a significant difference between the groups. CONCLUSION Our findings suggest that i-CRT followed by pneumonectomy is feasible, with a similar survival benefit to lobectomy. Thus, pneumonectomy after i-CRT should not be avoided as it is a potentially curative intent strategy for carefully selected patients.
Collapse
|
29
|
Affiliation(s)
- Jean Yannis Perentes
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| |
Collapse
|
30
|
Demographics, Safety and Quality, and Prognostic Information in Both the Seventh and Eighth Editions of the TNM Classification in 18,973 Surgical Cases of the Japanese Joint Committee of Lung Cancer Registry Database in 2010. J Thorac Oncol 2018; 14:212-222. [PMID: 30316011 DOI: 10.1016/j.jtho.2018.10.002] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/14/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The Japanese Joint Committee of Lung Cancer Registry performed the fourth nationwide registry study of surgical cases. Demographics, safety and quality, prognostic information, and correlations between the seventh and the eighth editions of the TNM classification were investigated. The principal results were compared with those of previous Japanese Joint Committee of Lung Cancer Registry studies. METHODS The clinicopathologic profiles, staging, and prognosis of patients who had an operation for primary lung cancer in 2010 were retrospectively collected in 2016 and analyzed. RESULTS The cohort consisted of 18,973 patients from 297 hospitals (11,771 males, mean age 68.3 years). Tumor smaller than 2.0 cm was seen in 39.0% of patients, and limited resection was performed in 22.7%. The 30- and 90-day mortality rates were 0.43 and 1.26%, respectively. The overall and disease-free survival rates at 5 years were 74.7 and 67.8%, respectively. The respective 5-year survival rates by pathological stage in the seventh edition in the present study (2010) and in the previous study (2004) were 88.9% and 86.8% for stage IA, 76.7% and 73.9% for stage IB, 64.1% and 61.6% for stage IIA, 56.1% and 49.8% for stage IIB, 47.9% and 40.9% for stage IIIA, 30.2% and 27.8% for stage IIIB, and 36.1% and 27.9% for stage IV. The 5-year survival rates by clinical stage in the eighth edition in the present study were 97.0% for stage 0, 91.6% for stage IA1, 81.4% for stage IA2, 74.8% for stage IA3, 71.5% for stage IB, 60.2% for stage IIA, 58.1% for stage IIB, 50.6% for stage IIIA, 40.5% for stage IIIB, 37.5% for stage IIIC, and 36.0% for IVA/B. With restaging, the overall survival rates of clinical stage IA and IB in the seventh edition were stratified into stages 0 to IA3 and stages IA1 to IIA in the eighth edition, respectively. CONCLUSIONS This study demonstrates improved surgical results for lung cancer in Japan. The TNM revision for the eighth edition was supported by the assessment of stage migration from the previous edition and the prognostic stratification.
Collapse
|
31
|
Waseda R, Iwasaki A. Extended sleeve lobectomy: its place in surgical therapy for centrally located non-small cell lung cancer and a review of technical aspects. J Thorac Dis 2018; 10:S3103-S3108. [PMID: 30430026 DOI: 10.21037/jtd.2018.07.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| |
Collapse
|
32
|
Abstract
Standard sleeve resection refers to the circumferential removal of a segment of the main bronchus in continuity with a lobectomy in order to avoid pneumonectomy. By doing so, surgery can be carried out in patients with compromised pulmonary function while also benefiting those with more normal function. It is most often indicated for malignant tumors located at the origin of the right upper lobe bronchus. Operative mortality is low and in the range of 2% to 3%, and quality of life and long-term survival are better than what is observed after pneumonectomy.
Collapse
|
33
|
Cohen C, Berthet JP. Extended-sleeve lobectomy: a technically demanding last-ditch effort in lung sparing surgery for central tumor. J Thorac Dis 2018; 10:S2211-S2214. [PMID: 30123564 DOI: 10.21037/jtd.2018.06.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Charlotte Cohen
- Department of Thoracic surgery, University Hospital of Nice, Nice, France
| | | |
Collapse
|
34
|
Li N, Tan F, Li J, Shao K, Zhao J, Mu J, Gao S, He J. Blind spot in lung cancer lymph node metastasis: Cross-lobe peripheral lymph node metastasis in early stage patients. Thorac Cancer 2018. [PMID: 29517861 PMCID: PMC5879049 DOI: 10.1111/1759-7714.12620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND At present, it has not yet been determined whether metastasis can be transferred cross-lobe to peripheral lymph nodes (LNs) from other lobes in early stages of lung cancer, especially without any direct involvement to the pleura and parenchyma of the lobe. This study was conducted to investigate this issue. METHODS A retrospective analysis was conducted at the Chinese Academy of Medical Sciences. Patients undergoing right middle and lower lobectomy with lymphadenectomy for preoperative clinical stage Ia-IIIa from 2014 to 2015 were identified. To avoid interference, cases were limited to tumors within the primary lobe. When a tumor is completely located in the lower lobe, no direct invasion occurs into the visceral pleura/bronchus/parenchyma of the middle lobe and tumor cell metastasis into the peripheral LNs (stations 12-14) in the middle lobe is defined as cross-lobe lymph node metastasis (CLM). RESULTS A total of 68 patients were identified, of which nine (13.2%) had CLM. Seven had squamous cell carcinoma, one adenocarcinoma, and one small cell carcinoma. Seven cases (77.8%) had intermediate bronchus invasion, and seven cases (77.8%) intermediate bronchus adjacent lymph node involvement (station 11). Compared to non-CLM patients, tumor diameter (5.2 vs. 3.2; P = 0.28), N2 lymph node metastasis rate (66.7% vs. 28.8%; P = 0.03), late stage (IIIa 77.8% vs. 35.6%; P = 0.04), and invasion of intermediate bronchus (77.8% vs. 45.8%; P = 0.07) relatively increased. CONCLUSION Non-primary lobe peripheral LN metastasis exists in lung cancer and requires greater attention and further study.
Collapse
Affiliation(s)
- Ning Li
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiagen Li
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Shao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
35
|
Wang L, Pei Y, Li S, Zhang S, Yang Y. Left sleeve lobectomy versus left pneumonectomy for the management of patients with non-small cell lung cancer. Thorac Cancer 2018; 9:348-352. [PMID: 29341464 PMCID: PMC5832469 DOI: 10.1111/1759-7714.12583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The study was conducted to compare the outcomes of sleeve lobectomy (SL) and pneumonectomy (PN) for management of the left lung in patients with non-small cell lung cancer (NSCLC). METHODS One hundred and thirty-five patients who underwent left SL (n = 87) or left PN (n = 48) for NSCLC from January 2006 to December 2011 were enrolled in this retrospective study. Left SL was performed when technically possible. The clinicopathological features and treatment outcomes in both groups were compared. Survival was evaluated using the Kaplan-Meier method, and significant differences were calculated using the log-rank test. Multivariate analysis was conducted using the Cox proportional hazards model to analyze significant variables associated with the outcomes of left SL. RESULTS There were no significant differences in general clinicopathological features (age, gender, lymph node metastasis, pathological stage, and complications of bronchial fistula) between patients who underwent left SL and left PN. The operation duration was markedly longer and the extent of bleeding was greater for left SL than left PN; however patients who underwent left SL achieved significantly longer overall survival than patients who underwent left PN. The outcomes of left SL were only associated with pathological stage. CONCLUSIONS Our results indicate that left SL may offer superior survival than left PN in selected patients. If anatomically feasible, left SL may be a preferred alternative to left PN for NSCLC patients. Pathological stage is an important factor to determine the outcome of SL.
Collapse
Affiliation(s)
- Liang Wang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - YuQuan Pei
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - ShaoLei Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - ShanYuan Zhang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| | - Yue Yang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| |
Collapse
|
36
|
Maurizi G, Ciccone AM, Vanni C, D’Andrilli A, Ibrahim M, Andreetti C, Menna C, Tierno SM, Venuta F, Rendina EA. Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results†. Eur J Cardiothorac Surg 2018; 53:1180-1185. [DOI: 10.1093/ejcts/ezx494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/02/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio D’Andrilli
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Simone M Tierno
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
- Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, Rome, Italy
- Lorillard Spencer Cenci Foundation, Rome, Italy
| |
Collapse
|
37
|
Abdelsattar ZM, Shen KR, Yendamuri S, Cassivi S, Nichols FC, Wigle DA, Allen MS, Blackmon SH. Outcomes After Sleeve Lung Resections Versus Pneumonectomy in the United States. Ann Thorac Surg 2017; 104:1656-1664. [DOI: 10.1016/j.athoracsur.2017.05.086] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 11/26/2022]
|
38
|
Horan S, Battoo A, Yendamuri S. Sleeve lobectomy for lung cancer. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
39
|
Advantage of Induction Chemoradiotherapy for Lung Cancer in Securing Cancer-Free Bronchial Margin. Ann Thorac Surg 2017; 104:971-978. [DOI: 10.1016/j.athoracsur.2017.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 02/07/2017] [Accepted: 03/21/2017] [Indexed: 11/18/2022]
|
40
|
Sleeve lobectomy may provide better outcomes than pneumonectomy for non–small cell lung cancer. A decade in a nationwide study. J Thorac Cardiovasc Surg 2017; 153:184-195.e3. [DOI: 10.1016/j.jtcvs.2016.09.060] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/15/2016] [Accepted: 09/23/2016] [Indexed: 11/19/2022]
|
41
|
Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Bronchial and arterial sleeve resection for centrally-located lung cancers. J Thorac Dis 2016; 8:S872-S881. [PMID: 27942409 DOI: 10.21037/jtd.2016.06.48] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of bronchial and arterial sleeve resections for the treatment of centrally-located lung cancers, when available, has become the option of choice in comparison with pneumonectomy (PN). Technical expertise, in particular in vascular reconstruction, and perioperative management improved over time allowing excellent short-term and long-term results. This is even truer if considering literature data from the main experiences published in the last years. These evidences have given to such lung sparing reconstructive procedures more and more acceptance among the surgical community. This article focuses on the main technical aspects and literature data regarding bronchovascular sleeve resections.
Collapse
Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;; Lorillard Spencer-Cenci Foundation, Rome, Italy
| |
Collapse
|
42
|
Jeon JH, Kim MS, Moon DH, Yang HC, Hwangbo B, Kim HY, Lee JM, Lee GK. Prognostic Differences in Subgroups of Patients With Surgically Resected T3 Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 102:1630-1637. [PMID: 27650104 DOI: 10.1016/j.athoracsur.2016.04.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study determined the characteristics and prognosis of each descriptor of T3 non-small cell lung cancer (NSCLC). METHODS A total of 3,241 patients underwent an operation for NSCLC between 2001 and 2013, and this study included 461 patients who received complete anatomic resection of T3 NSCLC. The T3 descriptors were coded as follows: tumor invading main bronchus within 2 cm of the carina (T3-cent), tumor invading beyond visceral pleura (T3-inv), tumor larger than 7 cm (T3-size), separate tumor nodules (T3-sep), or tumor with combined T3 descriptors (T3-comb). RESULTS The T3 distribution was as follows: T3-cent, 75 patients (16.3%); T3-inv, 157 patients (34.1%); T3-size, 132 patients (28.6%); T3-sep, 34 patients (7.4%); and T3-comb, 63 patients (13.7%). Subgroup analyses revealed a significant survival benefit in the T3-cent group compared with the other groups (all p < 0.05). The 5-year disease-free survival (DFS) values were 55.4%, 36.7%, 40.9%, 30.3%, and 32.0% in the T3-cent, T3-inv, T3-size, T3-sep, and T3-comb subgroups, respectively. Multivariable analyses revealed that age (p = 0.019), N status (p = 0.001), adjuvant chemotherapy (p < 0.001), and T3 descriptors (T3-cent versus others, p < 0.001) were the most important independent prognostic factors for DFS. Additional analyses were performed to evaluate prognostic factors for DFS in the T3-cent group. Multivariable analysis revealed that bronchoplastic procedures (p = 0.004) was an independent prognostic factor for DFS. CONCLUSIONS Survival for centrally located T3 NSCLC is better than other types of T3 NSCLC. Lung-preserving operations such as bronchoplastic procedures might result in improved survival of these patients.
Collapse
Affiliation(s)
- Jae Hyun Jeon
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Moon Soo Kim
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
| | - Duk Hwan Moon
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Hee Chul Yang
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Bin Hwangbo
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Hyae Young Kim
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Jong Mog Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Geon-Kook Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| |
Collapse
|
43
|
Tagawa T, Iwata T, Nakajima T, Suzuki H, Yoshida S, Yoshino I. Evolution of a Lung-Sparing Strategy with Sleeve Lobectomy and Induction Therapy for Non-small Cell Lung Cancer: 20-Year Experience at a Single Institution. World J Surg 2016; 40:906-12. [PMID: 26711642 PMCID: PMC4767866 DOI: 10.1007/s00268-015-3330-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background To elucidate the evolution of a lung-sparing strategy with sleeve lobectomy (SL) and induction therapy for non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed 205 patients with NSCLC who underwent pneumonectomy (PN, n = 54) or SL (n = 151) from 1994 to 2013. The study period was divided into four 5-year periods, and surgical trends were analyzed, focusing on the PN:SL ratio. Results PN was associated with a significantly advanced pathological stage, a larger tumor size and less pulmonary function compared with SL. The PN group had higher 30-day (3.7 vs. 0 %, p = 0.018) and 90-day (13.0 vs. 1.3 %, p = 0.0003) mortality than the SL group. The overall 5-year survival rate was significantly higher with SL (71.5 %) versus PN (42.8 %, p = 0.011) for patients with pN0–1. The ratio of PN among total surgeries decreased significantly over the four periods (1994–1998, 1999–2003, 2004–2008, and 2009–2013) from 5.63 % to 3.17, 1.40, and 1.38 %, respectively (p < 0.0001); in contrast, the PN:SL ratio increased significantly from 1.64 to 2.50, 3.71, and 5.44, respectively (p = 0.041). During the last period, when we introduced induction therapy, 38 of 651 who received surgery underwent induction therapy. The PN:SL ratios of those who did and did not undergo induction therapy were 15 (PN: 1, SL: 15) and 4.25 (PN: 8, SL: 34), respectively. Conclusions A lung-sparing strategy with SL for NSCLC can decrease the PN rate to less than 2 % with less mortality. Induction therapy may facilitate SL and increase the PN:SL ratio.
Collapse
Affiliation(s)
- Tetsuzo Tagawa
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Takekazu Iwata
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Shigetoshi Yoshida
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba, 260-8670, Japan.
| |
Collapse
|
44
|
Pan X, Gu C, Wang R, Zhao H, Shi J, Chen H. Initial Experience of Robotic Sleeve Resection for Lung Cancer Patients. Ann Thorac Surg 2016; 102:1892-1897. [PMID: 27623274 DOI: 10.1016/j.athoracsur.2016.06.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to identify the technical aspects and short-term results of robotic sleeve resection for lung cancer patients. METHODS Twenty-one consecutive cases of robotic sleeve resection from September 2014 to September 2015 were reviewed. RESULTS There were 17 single sleeve resection (bronchial) and 4 double sleeve resection (bronchial and vascular) cases. Nineteen of 21 cases (90.5%) achieved R0 resection. The mean console time was 120.4 ± 37.3 minutes. The mean operation time was 158.4 ± 42.0 minutes. There was no massive bleeding (800 mL or more) during operation. The mean intraoperative blood loss was 157.1 ± 97.8 mL. One case (4.8%) was converted to thoracotomy owing to severe calcification of lymph node. There was no intraoperative death. The overall complication rate was 19.0%. The major complications were subcutaneous emphysema (14.4%), cardiac arrhythmia (9.6%), pneumonia (9.6%), pyothorax (9.6%), bronchial anastomosis bleeding (4.8%), bronchial anastomosis leakage (4.8%), and multiple organ failure (4.8%). The 30-day mortality rate was 4.8%. The mean postoperative length of stay was 10.7 ± 7.6 days. CONCLUSIONS Robotic sleeve resection is technically feasible and can be carried out with acceptable short-term results.
Collapse
Affiliation(s)
- Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
45
|
Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Reconstruction of the bronchus and pulmonary artery. J Thorac Dis 2016; 8:S168-80. [PMID: 26981268 DOI: 10.3978/j.issn.2072-1439.2016.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Bronchovascular reconstructive procedures employed in order to avoid pneumonectomy (PN) in patients functionally unsuitable have provided, over time, excellent results, similar or even better than those obtained by PN. In recent years, new successful techniques have been developed that pertain in particular the prevention of major complications and the reconstruction of the pulmonary artery (PA). Encouraging data from increasing number of published experiences support the choice of parenchymal sparing procedures for lung cancer also in patients with good functional reserve. This is even more true if considering trials published in the last 10 years, thus indicating that improved outcome can be achieved with increased experience in reconstructive techniques and perioperative management. This article discusses the main technical aspects and results of literature.
Collapse
Affiliation(s)
- Giulio Maurizi
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Antonio D'Andrilli
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Federico Venuta
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Erino Angelo Rendina
- 1 Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy ; 2 Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy ; 3 Lorillard Spencer Cenci Foundation, Rome, Italy
| |
Collapse
|
46
|
Zhao LL, Zhou FY, Dai CY, Ren YJ, Jiang GN, Fei K, Chen C. Prognostic analysis of the bronchoplastic and broncho-arterioplastic lobectomy of non-small cell lung cancers-10-year experiences of 161 patients. J Thorac Dis 2016; 7:2288-99. [PMID: 26793350 DOI: 10.3978/j.issn.2072-1439.2015.12.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bronchoplastic and broncho-arterioplastic lobectomy is technically demanding. Present study performed a prognostic analysis of lobectomy patient based on 10-year data in a high-volume center. METHODS Overall, 161 non-small cell lung cancer (NSCLC) cases underwent bronchoplastic and broncho-arterioplastic lobectomy between January 2004 and November 2013. Follow-up information was obtained for 88.8% patients. Prognostic analysis was performed with the Cox proportional hazards model. RESULTS There were 133 bronchoplastic and 28 broncho-arterioplastic procedures. In detail, 97 sleeve and 64 wedge broncho-resection and reconstructions were conducted; pulmonary artery sleeve reconstructions were performed in 26 cases and tangential resection in 135 cases. 90-day post-operative mortality was 3.1% (5/161), and 24.8% (40/161) patients had post-operative complications. 5-year overall survival was 53.4% and 5-year disease-free survival (DFS) was 48.2% for the entire case series; these survival rates were 67.7% and 55.7% for stage I (n=31), 64.4% and 58.9% for stage II (n=62), and 36.9% and 31.9% for stage III disease, respectively. Univariate analysis revealed that age >65 and higher grade of pN were associated with worse overall survival while right side tumor, non-squamous histology type, and higher grade of pT and pN were associated with worse DFS. Multivariate analysis revealed that pN is the only independent factor of worse outcome. CONCLUSIONS Bronchoplastic and broncho-arterioplastic lobectomy are safe procedures for indicated NSCLC patients associated with a low rate of post-operative complications but favorable long-term survival. Recognition of prognostic factors helps improve outcomes for these patients.
Collapse
Affiliation(s)
- Li-Lan Zhao
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Fang-Yu Zhou
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chen-Yang Dai
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yi-Jiu Ren
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ge-Ning Jiang
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ke Fei
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| |
Collapse
|
47
|
Fan J, Wang Q, Yao J, Chang Z. Left lower sleeve lobectomy and systematic lymph node dissection by single-incision video-assisted thoracic surgery. J Thorac Dis 2015; 7:1865-9. [PMID: 26623113 PMCID: PMC4635291 DOI: 10.3978/j.issn.2072-1439.2015.10.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/07/2015] [Indexed: 11/14/2022]
Abstract
Sleeve lobectomy for selected cases of intratracheal tumor has better parenchyma preservation compared to pneumonectomy. And the left lower sleeve lobectomy is considered one of the most complex resections. Thanks to the advancement of equipment and accumulation of skills, video-assisted thoracic surgery (VATS) sleeve lobectomy has become safe and feasible. Typically, 3-4 ports are used, but the surgery can also be completed through one incision. A 51-year-old male patient with left lower central lung cancer underwent sleeve lobectomy and systematic mediastinal lymphadenectomy by single-incision VATS and recovered uneventfully. Sleeve lobectomy by single-incision video-assisted thoracic surgery is feasible and safe.
Collapse
Affiliation(s)
- Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 31009, China
| | - Qi Wang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 31009, China
| | - Jie Yao
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 31009, China
| | - Zhibo Chang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 31009, China
| |
Collapse
|
48
|
Pan X, Tantai J, Lin L, Cao K, Zhao H. Comparison of short and long-term results between sleeve resection and pneumonectomy in lung cancer patients over 70 years old: 10 years experience from a single institution in China. Thorac Cancer 2014; 5:494-9. [PMID: 26767043 DOI: 10.1111/1759-7714.12116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the short and long-term results between sleeve resection (SR) and pneumonectomy (PN) in lung cancer patients over 70 years of age. METHODS We retrospectively reviewed 105 lung cancer patients over 70 years of age who had undergone SR or PN at Shanghai Chest Hospital from January 2003 to December 2012. RESULTS The SR group showed a higher frequency of airway clearance via bronchoscopy (48.6% vs. 25.7%, P = 0.04), longer surgical time (162.7 vs. 140.9 minutes, P = 0.01), and shorter postoperative stay (13.7 vs. 18.1 days, P = 0.02) than the PN group. There was no difference in hospital mortality (P = 1.00) or morbidity (P = 0.40) between the two groups. A logistic regression model showed that preoperative predicted forced expiratory volume in 1 second was the only independent risk factor for overall morbidity (P = 0.04). In survival analysis, SR showed better prognosis than PN (median 50.0 vs. 20.0 months, P < 0.01). In subgroup analysis, SR showed better survival in N0 (P = 0.03) and N1 (P < 0.01) cases, but not in N2 cases (P = 0.36). It also showed better survival in stage I + II patients (P = 0.03), but not in stage III patients (P = 0.10). CONCLUSIONS Although PN could be carried out as safely as SR in patients over 70 years of age with a good pulmonary reservoir, SR is still recommended as a less traumatic procedure, sparing lung parenchyma with better long-term results.
Collapse
Affiliation(s)
- Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai, China
| | - Jicheng Tantai
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai, China
| | - Ling Lin
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai, China
| | - Kejian Cao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai, China
| |
Collapse
|
49
|
Extended sleeve lobectomy after induction chemoradiotherapy for non-small cell lung cancer. Surg Today 2014; 45:1121-6. [DOI: 10.1007/s00595-014-1025-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/21/2014] [Indexed: 10/23/2022]
|
50
|
Shin S, Park JS, Shim YM, Kim HJ, Kim J. Carinal resection and reconstruction in thoracic malignancies. J Surg Oncol 2014; 110:239-44. [PMID: 24888321 DOI: 10.1002/jso.23643] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/10/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to present clinical outcomes of malignant tumors involving the carina after surgery in order to establish the management guidelines. METHODS Between 1996 and 2011, 30 patients underwent carinal resection and reconstruction for malignancy involving carina. We retrospectively analyzed their medical records. There were 22 cases of common type of NSCLC (squamous cell carcinoma/adenocarcinoma/large cell neuroendocrine carcinoma) and eight cases of carcinomas of salivary gland type (adenoid cystic carcinoma/mucoepidermoid carcinoma). RESULTS Seventeen right sleeve pneumonectomies, two left sleeve pneumonectomies, nine carinal sleeve right upper lobectomies, and two airway resections and reconstructions without lung resection were performed. There were no in-hospital mortalities. Eleven postoperative morbidities occurred including three cases of acute respiratory distress syndrome following pneumonectomy. Late complications occurred in eight patients including three cases of anastomotic stenosis. During follow-up, 12 mortalities occurred, including 6 cancer-related mortalities. The 5-year overall survival rate (OS) and disease-free survival rate (DFS) were 66.3% and 52.9%, respectively. CONCLUSIONS Malignant tumors involving the carina can be controlled with carinal surgery with acceptable mortality and morbidity. Patients with thoracic malignancy involving the carina should be considered as surgical candidate based on disease extent and functional status.
Collapse
Affiliation(s)
- Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|