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Yin H, Shi D, Luo R, Liu S, Wan Q, Shi H. Lung invasive adenocarcinoma extended into the left atrium visualized by 18F-FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2023; 42:43-45. [PMID: 34593350 DOI: 10.1016/j.remnie.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/01/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Hongyan Yin
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dai Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Siwei Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan Wan
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
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2
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Yin H, Shi D, Luo R, Liu S, Wan Q, Shi H. Adenocarcinoma invasivo de pulmón con extensión a la aurícula izquierda visualizado por imágenes de PET/TC con18F-FDG. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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Yanagawa B, Chan EY, Cusimano RJ, Reardon MJ. Approach to Surgery for Cardiac Tumors: Primary Simple, Primary Complex, and Secondary. Cardiol Clin 2019; 37:525-531. [PMID: 31587792 DOI: 10.1016/j.ccl.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cardiac tumors are rare. Most surgeons will encounter few primary cardiac tumors outside of myxomas. This article offers the authors' approach to simple and complex primary and secondary cardiac tumors. Symptoms of primary cardiac tumors are primarily determined by tumor size and anatomic location. Most simple primary tumors and some complex primary tumors are best managed by surgical resection. Secondary tumors are 30 times more frequent than primary cardiac tumors. Surgical resection of secondary tumors is rational in a few highly selected patients. For complex primary and secondary tumors, the authors recommend referral to an experienced multidisciplinary cardiac tumor team.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Edward Y Chan
- Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1401, Houston, TX 77030, USA
| | - Robert J Cusimano
- Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin Street, Suite 1401, Houston, TX 77030, USA.
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4
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Chandra R, Abugroun A, Goldberg A, Cooney E, Mehrotra S, Volgman A. Small Cell Lung Cancer Invading the Left Atrium With Subsequent Malignant Embolic Stroke: A Case Report and Review of Literature. Cardiol Res 2019; 10:188-192. [PMID: 31236182 PMCID: PMC6575106 DOI: 10.14740/cr752w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/22/2018] [Indexed: 11/24/2022] Open
Abstract
Cardiac tumors are uncommon, and the vast majority of them are metastases from extracardiac sources. Metastatic spread to the heart causes symptoms by mechanical obstruction of circulation, direct myocardial invasion, or distal embolization. We herein report a case of a 58-year-old male who presented to the hospital with multilobar intracranial embolic infarcts who was found to have small cell lung cancer (SCLC) with invasion of the left atrium and pulmonary artery resulting in malignant embolic stroke. Cerebral tumor thromboembolism from SCLC is extremely rare. This case demonstrates the thromboembolic risk associated with metastatic endoluminal cardiac tumors.
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Affiliation(s)
| | | | | | | | - Swati Mehrotra
- Department of Pathology, Stritch School of Medicine of Loyola University, Maywood, IL 60153, USA
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5
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Yanagawa B, Mazine A, Chan EY, Barker CM, Gritti M, Reul RM, Ravi V, Ibarra S, Shapira OM, Cusimano RJ, Reardon MJ. Surgery for Tumors of the Heart. Semin Thorac Cardiovasc Surg 2018; 30:385-397. [PMID: 30205144 DOI: 10.1053/j.semtcvs.2018.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
Most surgeons will encounter only a handful of primary cardiac tumors outside of myxomas. Approximately 3 quarters of primary cardiac tumors are benign and 1 quarter is malignant. In most cases, cardiac tumors are silent but when symptoms do occur, they are primarily determined by tumor size and anatomical location, not by histopathology. The diagnosis and preoperative imaging relies heavily on multimodal imaging including echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Surgical resection is the most common treatment for most simple primary cardiac tumors and for some complex benign tumors. Surgical resection of primary cardiac tumors frequently involves the need for complex cardiac reconstruction, particularly when malignant. Secondary tumors to the heart are 30 times more frequent than primary cardiac tumors, and their incidence is increasing, largely as a result of advances in cancer diagnosis and therapy. Surgical resection is feasible in only a small fraction of highly-selected patients with secondary tumors to the heart. For complex benign tumors-such as paraganglioma or large fibromas-and all primary and secondary malignant tumors, a multidisciplinary cardiac tumor team review in experienced centers of excellence is recommended.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Edward Y Chan
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Colin M Barker
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael Gritti
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ross M Reul
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Vinod Ravi
- Department of Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Sergio Ibarra
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, Jerusalem, Israel
| | - Robert J Cusimano
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
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6
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Dartevelle PG, Mitilian D, Fadel E. Extended surgery for T4 lung cancer: a 30 years’ experience. Gen Thorac Cardiovasc Surg 2017; 65:321-328. [DOI: 10.1007/s11748-017-0752-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022]
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7
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Belov YV, Komarov RN, Parshin VD, Yavorovsky AG, Chernyavsky SV, Mnatsakanyan GV. [Right-sided pneumonectomy with left atrium resection under cardiopulmonary bypass in the patient with lung cancer (the first case in Russia)]. Khirurgiia (Mosk) 2017:78-81. [PMID: 28209960 DOI: 10.17116/hirurgia2017178-81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yu V Belov
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - R N Komarov
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - V D Parshin
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - A G Yavorovsky
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - S V Chernyavsky
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
| | - G V Mnatsakanyan
- Clinic of Cardiovascular Surgery, University's Clinical Hospital #1, Sechenov First Moscow State Medical University, Moscow, Russia
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8
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Galvaing G, Tardy MM, Cassagnes L, Da Costa V, Chadeyras JB, Naamee A, Bailly P, Filaire E, Pereira B, Filaire M. Left atrial resection for T4 lung cancer without cardiopulmonary bypass: technical aspects and outcomes. Ann Thorac Surg 2014; 97:1708-13. [PMID: 24625436 DOI: 10.1016/j.athoracsur.2013.12.086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/19/2013] [Accepted: 12/30/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Extended resection for lung cancer may improve survival of selected patients. Left-atrial resection is infrequently performed and surgical techniques are rarely reported; thus, oncologic results and survival rates remain uncertain. Our study describes surgical techniques, postoperative outcomes, and oncologic results of patients who received a combined multimodality treatment. METHODS Between October 2004 and March 2012 in our institution, 19 patients underwent extended lung resection involving the left atrium without cardiopulmonary bypass. We reviewed perioperative treatments, surgical procedures, and postoperative morbidity, mortality, and long-term survival rates. RESULTS Sixteen patients (68.4%) underwent neoadjuvant treatment including chemotherapy or radiotherapy. Eighteen pneumonectomies (94.7%) were performed, of which 12 (63.1%) were right sided. Dissection of the interatrial septum was complete in 4 patients (33.3%). Complete resection was achieved in 17 patients (89.4%) and 2 other patients (10.5%) were considered R1. The T-status was pT4 in all patients. Overall postoperative morbidity was 52.6%. The 30-day mortality rate was 10.5% and the 90-day mortality rate was 15.7%. Fifteen patients (93.7%) underwent adjuvant treatment. The mean follow-up time was 32.5 months. The 5-year probability of survival was 43.7%. Three patients (15.7%) were alive at greater than 6 years postsurgery. CONCLUSIONS Extended lung surgery with partial resection of the left atrium is a feasible procedure with acceptable morbidity. An interatrial septum dissection, by increasing the length of the atrial cuff, allows complete resection. Long-term survival can be achieved in highly selected patients who have undergone multimodal therapy.
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Affiliation(s)
- Geraud Galvaing
- Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France; Clermont Université, Univ Clermont 1, Faculté de Médecine, Laboratoire d'anatomie, Clermont-Ferrand, France.
| | - Marie M Tardy
- Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France
| | - Lucie Cassagnes
- CHU Clermont-Ferrand, service de radiologie, Hôpital G. Montpied, Clermont-Ferrand, France; Centre National de Recherche Scientifique, Institut des Sciences de l'Image pour les Techniques interventionnelles, Unité Mixte de Recherche 6284
| | - Valinkini Da Costa
- Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France
| | - Jean Baptiste Chadeyras
- Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France
| | - Adel Naamee
- Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France
| | - Patrick Bailly
- Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France
| | - Edith Filaire
- Université Orléans, Laboratoire Complexité Innovation et Activités Motrices et Sportives, Equipe d'Accueil 452, Université Paris-Sud; Orléans, France; Unité de Formation et de Recherche Sciences et Techniques des Activités Physiques et Sportives, 2 allée du Château, Orléans, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, The biostatistic division, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marc Filaire
- Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France; Clermont Université, Univ Clermont 1, Faculté de Médecine, Laboratoire d'anatomie, Clermont-Ferrand, France; Institut Nationale de Recherche Agronomique, Unité Mixte de Recherche 1019, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France
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9
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Muralidaran A, Detterbeck FC, Boffa DJ, Wang Z, Kim AW. Long-term survival after lung resection for non–small cell lung cancer with circulatory bypass: A systematic review. J Thorac Cardiovasc Surg 2011; 142:1137-42. [DOI: 10.1016/j.jtcvs.2011.07.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/26/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
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10
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Yuan SM, Shinfeld A, Raanani E. Cardiopulmonary bypass as an adjunct for the noncardiac surgeon. J Cardiovasc Med (Hagerstown) 2008; 9:338-55. [PMID: 18334888 DOI: 10.2459/jcm.0b013e3282eee889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of cardiopulmonary bypass (CPB) in noncardiac surgical settings has been increasingly developed and has greatly benefited noncardiac surgeon. A few years after the advent of CPB as well as profound hypothermic circulatory arrest in the early years, it was employed by neurosurgeons in cerebrovascular surgery and by general thoracic surgeons in carinal tumor resection. Indications for CPB were extended and modified year after year. It has facilitated not only the surgical management by surgeons of lesions that cannot be managed safely and effectively by conventional techniques, or conventional techniques carry significant risks to the patient, but also the preservation of the viability of multiple organ procurement, the practice of isolated limb perfusion for the treatment of malignancies of the extremities, and emergent cardiopulmonary resuscitation. Owing to the complications arising from CPB and profound hypothermic circulatory arrest, such as postoperative bleeding, coagulopathy, and neurologic deficits, efforts have been made to avoid these common hazards. Thus, innovative techniques including extracorporeal membrane oxygenation, percutaneous cardiopulmonary support, venovenous bypass, normothermic CPB, and minimally invasive approaches have emerged and played an important role as alternatives of standard CPB in decreasing morbidity and mortality and improving survival.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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11
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Anatomical bases of the surgical dissection of the interatrial septum: a morphological and histological study. Surg Radiol Anat 2008; 30:369-73. [PMID: 18330490 DOI: 10.1007/s00276-008-0334-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 02/28/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The interatrial septum (IAS) can be dissected to resect pulmonary tumors invading the left atrium. The aim of this study was to describe the dissected structures, and to expose the benefits, the limits, and the embryologic reasons of such dissection. METHODS We dissected the IAS of 11 fresh, non-embalmed human hearts. The dissected structures were described and the length and depth of the dissection were measured. A histological study was performed in four other fresh hearts to identify and differentiate between dissectible and non-dissectible structures. RESULTS The dissection was performed through a fatty tissue located between two muscular walls. The depth limit of the IAS dissection was identified as the limbus of the fossa ovalis and the muscular roof of the atria. The section of the latter doubles the depth of the dissection at the level of the upper pulmonary veins. Mean length of the dissected IAS was 77 mm (55-90). Mean depths of the IAS were 41 mm (35-50) at the level of the left upper pulmonary vein, 27 mm (12-35) between the upper and lower pulmonary veins, and 14 mm (8-20) at the level of the left inferior pulmonary vein CONCLUSION The surgical dissection of the IAS is performed through the septum secundum that appears as an infold of the atrial wall. The length of the resectable left atrial cuff reaches a mean of 40 mm at the level of the upper pulmonary vein.
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12
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Lung Neoplasms. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Sales Badia JG, Galbis Caravajal JM, Viñals Larruga B, Luna Arnal D, Cordero Rodríguez P, Cuevas Sanz JM. Neumonectomía por metástasis pulmonar con utilización de circulación extracorpórea. Arch Bronconeumol 2007. [DOI: 10.1157/13099537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Spaggiari L, D' Aiuto M, Veronesi G, Pelosi G, de Pas T, Catalano G, de Braud F. Extended Pneumonectomy With Partial Resection of the Left Atrium, Without Cardiopulmonary Bypass, for Lung Cancer. Ann Thorac Surg 2005; 79:234-40. [PMID: 15620949 DOI: 10.1016/j.athoracsur.2004.06.100] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Extended pneumonectomy with partial resection of the left atrium for lung cancer is not frequently performed; therefore, its results remain controversial. The present study analyzed a single center's experience with this extended surgery, highlighting the surgery's technical aspects, postoperative outcomes, and oncologic results. METHODS From November 1996 to December 2003, 15 patients underwent extended pneumonectomy with partial resection of the left atrium for lung cancer, without cardiopulmonary bypass. RESULTS Of the 15 patients (median age of 63 years, range 35 to 74 years), 11 were men (73%) and 4 were women. Six patients (40%) underwent preoperative invasive mediastinal staging. Nine patients (60%) underwent induction chemotherapy. Nine patients (60%) underwent right pneumonectomy. Pathologic analysis of the specimens identified 8 patients (53%) with N2 disease, 5 patients (33%) with N1 disease, and 2 patients with N0 disease. The T status was T4 in 10 patients, pT3 in 3 patients, and T0 in the remaining 2 patients. The were 10 squamous cell carcinomas (60%), 2 adenocarcinomas, 1 adenosquamous carcinoma, 1 mucoepidermoid carcinoma, and 1 atypical carcinoid tumor. The median intensive care unit and hospital stay were 1 day and 6.4 days, respectively. There were only two (15.3%) minor postoperative complications (atrial arrhythmias), which were successfully treated medically. There was no postoperative mortality. At completion of the study, 9 patients (60%) were still alive, with 8 showing no evidence of disease. The remaining 6 patients died because of systemic recurrences. The 3-year probability of survival was 39%. CONCLUSIONS Extended pneumonectomy with partial resection of the left atrium for advanced lung cancer is a feasible procedure, with low postoperative morbidity and mortality. In fact, it can lead to excellent local control of the disease, if not to a permanent cure in select patients.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery European Institute of Oncology, Milan, Italy.
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15
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Ratto GB, Costa R, Vassallo G, Alloisio A, Maineri P, Bruzzi P. Twelve-year experience with left atrial resection in the treatment of non–small cell lung cancer. Ann Thorac Surg 2004; 78:234-7. [PMID: 15223435 DOI: 10.1016/j.athoracsur.2004.01.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND We retrospectively reviewed our 12-year experience in the surgical treatment of non-small cell lung cancer invading the left atrium. End points of the study were overall survival and factors potentially affecting survival. METHODS Nineteen consecutive patients with lung cancer invading the left atrium underwent surgery. Three patients with N2 disease underwent induction chemotherapy. Patients with either incomplete resections or pN2 disease received postoperative chemoradiotherapy. RESULTS Five-year survival was 14%, and the median survival time was 25 months. These figures refer to a very homogeneous group of patients with respect to the extent of atrial infiltration. Patients with N2 disease tended to have a worse outcome than patients with N0 or N1 disease (p = 0.06). The 3 patients with N2 disease who underwent induction chemotherapy were alive and disease-free at 30, 15, and 11 months from surgery. Survival was not affected by histology, type of surgery, or completeness of resection. Three patients with residual cancer in the atrial resection margin underwent postoperative chemoradiotherapy and are alive at 25, 17, and 15 months after surgery. CONCLUSIONS In spite of the poor survival rates we report, the present experience suggests that more-favorable results could be expected by the routine preoperative use of positron emission tomographic scan staging, a more-extensive assessment of atrial invasion, the application of induction chemotherapy in patients with N2 disease, and postoperative chemoradiotherapy in patients with tumors abutting the atrial resection margin.
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Affiliation(s)
- Giovanni B Ratto
- Department of Thoracic Surgery, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy.
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16
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Abstract
T4 lung cancers are a heterogeneous group of locally advanced lung cancers. Treatment is palliative for the majority of patients, ranging from supportive care to chemoradiotherapy. In certain patients, however, surgery is beneficial and may be curative. Patients with T4N0M0 cancers invading the distal trachea, carina, left atrium, aorta, superior vena cava, or vertebral bodies may be surgical candidates. Radical resections of these T4 lung cancers have potential for cure if no mediastinal lymph node metastases (N2 or N3) occur and if resection is complete. Increased postoperative mortality exists and extends beyond 30 days, as evidenced by a 30-day mortality of 8% and a 90-day mortality of 18%. Improved palliation (median survival of 19 months) and cure (31% five-year survival) are possible in patients who meet the criteria, who undergo radical resection, and who are followed by physicians in facilities with special interests in extended resections. The use of induction therapy and surgery in T4 patients may further increase survival and the number of T4 patients in whom radical resection is possible. Radical resections are contraindicated in patients with T4 lung cancers associated with malignant pleural effusions. Unfortunately, these patients have the worst prognosis. If surgical palliation is an option, only pulmonary resection with pleurectomy and not pleuropneumonectomy should be considered. In contrast, lung cancers with the best prognosis are those T4 tumors diagnosed because of a satellite tumor nodule within the same lobe. Because radical resections are usually not required, operative mortality is not increased. Five-year survival in patients with satellite intralobar tumor nodules without mediastinal nodal metastases is comparable to survival of highly selected T4N0M0 patients who undergo radical resection. These two extremes of T4 lung cancers, malignant pleural effusion and satellite intralobar tumor nodules, generally are not considered for or do not require radical resections. It is debatable that the definition of T4 should include these entities.
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Affiliation(s)
- Thomas W Rice
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, OH 44195, USA.
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17
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Ferguson ER, Reardon MJ. Atrial resection in advanced lung carcinoma under total cardiopulmonary bypass. Tex Heart Inst J 2000; 27:110-2. [PMID: 10928496 PMCID: PMC101043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
There are few reports of a surgical approach to T4 lung carcinoma that has invaded the heart. Although most cases will be considered inoperable, cases in which there is potential for complete resection and no distant or nodal metastatic disease (T4 N0 M0, Stage IIIB) may be considered for surgical therapy. We report a case of squamous cell carcinoma of the lung with cardiac involvement, in which we performed a completion pneumonectomy using total cardiopulmonary bypass. We describe indications and techniques for use of cardiopulmonary bypass in such cases.
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Affiliation(s)
- E R Ferguson
- Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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18
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Ernst M, Koller M, Grobholz R, Moosdorf R. Both atrial resection and superior vena cava replacement in sleeve pneumonectomy for advanced lung cancer. Eur J Cardiothorac Surg 1999; 15:530-2. [PMID: 10371135 DOI: 10.1016/s1010-7940(99)00044-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Extended sleeve pneumonectomy including removal of the superior vena cava, right atrium and parts of left atrium on cardiopulmonary bypass was successfully performed in a 40-year-old man. The tumour was histologically proven a T4 N1 stage with margins free from tumour. Adjuvant radiochemotherapy was administered postoperatively on an outpatient base. The patient did well for 7 months then he died from myocardial infarction due to metastatic infiltration of the right coronary artery. Other metastatic deposits were not found at autopsy. More data from extended pulmonary resections are required to demonstrate a benefit.
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Affiliation(s)
- M Ernst
- Department of General Surgery, Philipps-University Marburg, Germany.
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19
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Suriani R, Konstadt S, Camunas J, Goldman M. Transesophageal echocardiographic detection of left atrial involvement of a lung tumor. J Cardiothorac Vasc Anesth 1993; 7:73-5. [PMID: 8431580 DOI: 10.1016/1053-0770(93)90123-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- R Suriani
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029
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