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Li X, Li Q, Yang F, Gao E, Lin L, Li Y, Song X, Duan L. Neoadjuvant therapy does not increase postoperative morbidity of sleeve lobectomy in locally advanced non-small cell lung cancer. J Thorac Cardiovasc Surg 2023; 166:1234-1244.e13. [PMID: 36965521 DOI: 10.1016/j.jtcvs.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES To evaluate the feasibility and safety of sleeve lobectomy after neoadjuvant therapy by assessing the postoperative morbidity. METHODS Patients who underwent sleeve lobectomy for non-small cell lung cancer (NSCLC) were retrospectively analyzed from January 2018 to December 2021. A total of 613 patients were enrolled, including 124 patients who received previous neoadjuvant therapy and 489 patients who did not. Propensity score matching was adopted to create a balanced cohort consisting of 97 paired cases. Patient demographics and perioperative outcomes were compared between the 2 groups, and logistic regression analysis was used to identify risk factors for postoperative complications. RESULTS In the entire cohort, univariable logistic regression analysis showed that smoking history (odds ratio [OR], 1.501; 95% confidence interval [CI], 1.011-2.229, P = .044), open thoracotomy (OR, 1.748; 95% CI, 1.178-2.593, P = .006), and operation time more than 150 minutes (OR, 1.548; 95% CI, 1.029-2.328, P = .036) were risk factors for postoperative complications, and multivariable logistic regression analysis showed open thoracotomy was an independent risk factor (OR, 1.765; 95% CI, 1.178-2.643, P = .006). In the balanced cohort, the neoadjuvant group had a lower proportion of double-sleeve resections (3.1% vs 11.3%, P = .035) and longer postoperative chest tube drainage (6.67 ± 3.81 vs 5.13 ± 3.74 days, P < .001). However, no significant differences were observed in postoperative morbidity between the 2 groups (25.8% vs 24.7%, P = .869). The complete pathologic response of chemoimmunotherapy was significantly superior to chemotherapy alone (28.2% vs 4.1%, P < .001), and no significant differences were noted in postoperative morbidity in different neoadjuvant therapy modalities. CONCLUSIONS After neoadjuvant therapy, sleeve lobectomy can be safely performed with no increased postoperative morbidity.
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Affiliation(s)
- Xiang Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fujun Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Erji Gao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yaqiang Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiao Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
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Nitsche LJ, Jordan S, Demmy T, Dexter E, Hennon M, Nwogu C, Yendamuri S, Picone A. Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients. J Thorac Dis 2023; 15:2497-2504. [PMID: 37324102 PMCID: PMC10267906 DOI: 10.21037/jtd-22-654] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Some patients with non-small cell lung cancer (NSCLC) have superior short- and long-term outcomes with sleeve lobectomy rather than pneumonectomy. Originally sleeve lobectomy was reserved for patients with limited pulmonary function, however, the reported superior results allowed sleeve lobectomy to be performed in expanded patient populations. In a further attempt to improve post-operative outcomes surgeons have adopted minimally invasive techniques Minimally invasive approaches have potential benefits to patients such as decreased morbidity and mortality while maintaining the same caliber of oncologic outcomes. METHODS We identified patients at our institution who underwent sleeve lobectomy or pneumonectomy to treat NSCLC from 2007 to 2017. We analyzed these groups in respect to 30- and 90-day mortality, complications, local recurrence, and median survival. We included multivariate analysis to determine the impact of a minimally invasive approach, sex, extent of resection, and histology. Differences in mortality were analyzed using the Kaplan-Meier method using the log-rank test to compare the groups. A two-tailed Z test for difference in proportions was done to analyze complications, local recurrence, 30-day and 90-day mortality. RESULTS A total of 108 patients underwent sleeve lobectomy (n=34) or pneumonectomy (n=74) for treatment of NSCLC with 18 undergoing open pneumonectomy, 56 undergoing video-assisted thoracoscopic surgery (VATS) pneumonectomy, 29 undergoing open sleeve lobectomy, and 5 undergoing VATS sleeve lobectomy. There was no significant difference in 30-day mortality (P=0.064) but there was a difference in 90-day (P=0.007). There was no difference in complication rates (P=0.234) or local recurrence rates (P=0.779). The pneumonectomy patients had a median survival of 23.6 months (95% CI: 3.8-43.4 months). The sleeve lobectomy group had a median survival of 60.7 months (95% CI: 43.3-78.2 months) (P=0.008). On multivariate analysis extent of resection (P<0.001) and tumor stage (P=0.036) were associated with survival. There was no significant difference between the VATS approach and the open surgical approach (P=0.053). CONCLUSIONS When considering patients undergoing surgery for NSCLC sleeve lobectomy resulted in lower 90-day mortality and better 3-year survival compared to patients undergoing PN. Having a sleeve lobectomy rather than a pneumonectomy and having earlier-stage disease lead to significantly improved survival on multivariate analysis. Having a VATS operation leads to a non-inferior post-operative outcome compared to open surgery.
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Affiliation(s)
- Lindsay J Nitsche
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sean Jordan
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Todd Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Elisabeth Dexter
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Chukwumere Nwogu
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
| | - Anthony Picone
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA
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Baram A, Ramzi RM, Al Bermani S. Pneumonectomy for left-sided non-small cell lung cancer: analysis of 111 cases over 10 years. J Int Med Res 2020; 48:300060519889472. [PMID: 32000543 PMCID: PMC7254167 DOI: 10.1177/0300060519889472] [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] [Indexed: 11/25/2022] Open
Abstract
Background Pulmonary resection is the preferred therapeutic option for non-small cell lung cancer (NSCLC). Despite the physiological insult, pneumonectomy (PN) may be unavoidable in patients with early-stage central tumors. This study aimed to analyze the management of early-stage left-sided NSCLC by PN. Methods This was a prospective observational study of patients with different stages of NSCLC who underwent left PN over a 10-year period. In-hospital morbidity and mortality and long-term survival were calculated. Results A total of 111 patients were enrolled (aged 46–80 years). Preoperatively, 53.2% of patients had stage IIIA, 32.4% stage IIB, and 14.4% had stage IIA disease. Postoperatively, the number of patients with stage IIA and IIB decreased while stage IIIA increased. All PNs were radical. The 5- and 10-year survival rates in stage IIA patients were 42.8% and14.2%, respectively, in stage IIB patients were 56.25% and 3.1%, and the 5-year survival in stage IIIA patients was 22. 5%. The overall 1-, 2-, 5-, and 10-year survival rates were 94.6%, 77.47%, 34.23%, and 2.7%, respectively. Conclusions The operative mortality, morbidity, and 5-year survival rates of patients with NSCLC after PN matched the international standards. Left PN might be unavoidable for patients with centrally located tumors.
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Affiliation(s)
- Aram Baram
- Department of Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimani, Al Sulaymaniyah, Kurdistan Region, Iraq.,Department of Thoracic and Cardiovascular Surgery, Sulaimani Teaching Hospital, Al Sulaymaniyah, Kurdistan Region, Iraq
| | - Ramzi Mowffaq Ramzi
- Department of Cardiothoracic and Vascular Surgery, Al Sulaymaniyah, Kurdistan Region, Iraq
| | - Salam Al Bermani
- Department of Thoracic Surgery, Sulaimani Directorate of Health, Teaching Hospital, Sulaymaniyah, Iraq
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Impact of Neoadjuvant Chemoradiation on Adverse Events After Bronchial Sleeve Resection. Ann Thorac Surg 2020; 112:890-896. [PMID: 33171174 DOI: 10.1016/j.athoracsur.2020.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with the incidence of postoperative pulmonary and airway complications. METHODS After instructional review board approval we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary and airway complications. Nonparametric testing of demographic, surgical, and pathologic characteristics and morbidity was performed. Logistic regression models evaluated postoperative pulmonary complications and airway complications. Analysis was performed using Stata/IC 15. RESULTS We analyzed 136 patients (18 underwent neoadjuvant chemoradiation), 77 (57%) of whom had non-small cell lung cancer. Postoperative pulmonary complications were observed in 44 of 136 patients (32%). Incidences of pulmonary complications were higher in the neoadjuvant chemoradiation group compared with the non-neoadjuvant radiation group (15/18 patients [83%] vs 29/118 patients [25%], respectively; P < .001). Likewise, rates of pneumonia, atelectasis, respiratory insufficiency, bronchial stenosis, prolonged air leak, bronchopleural fistula, and completion pneumonectomy (2/18 [11%]) were higher in the neoadjuvant chemoradiation group, reaching statistical significance in all cases except bronchial stenosis and prolonged air leak. Only neoadjuvant chemoradiation therapy remained significant for postoperative pulmonary and airway complications on logistic regression (both P < .05) CONCLUSIONS: Patients who undergo neoadjuvant chemoradiation before sleeve resection are at an increased risk of pulmonary and airway complications.
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The Initial Experience on Thoracoscopic Sleeve Lobectomy: Continuous Suturing Technique of the Bronchial Anastomosis in 12 Cases. Surg Laparosc Endosc Percutan Tech 2020; 30:476-479. [PMID: 32658121 DOI: 10.1097/sle.0000000000000831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleeve resection is a widely performed type of operation in the surgical treatment of non-small cell lung cancer. Video-assisted thoracoscopic surgery (VATS) is now used even in central tumor surgeries of the lung with the increasing technology and experience. Sleeve resection cases performed through VATS in our clinic in recent years were presented with demographic, surgical, pathologic, and survey characteristics. MATERIALS AND METHODS Twelve patients who underwent sleeve resection with VATS in our clinic between November 2015 and August 2019 were included in the study. Operative, pathologic, and postoperative characteristics of the patients were examined. RESULTS A total of 12 patients, 3 female and 9 male individuals, were included in the study. The mean age of the patients was 61.7±12.9 years. According to the localization of the tumors, left upper lobectomy was performed in 4 patients and 8 patients underwent right upper lobectomy. During the sleeve anastomosis of the patients, 3/0 prolene sutures were used in 5 patients (36%) and 4/0 prolene sutures in 4 patients (36%), whereas 3/0 polydioxanone suture (PDS) was used in 3 patients (28%). The mean operation time was 288.2±77.1 (205 to 460) minutes and the mean anastomosis time was 70±18.5 (55 to 110) minutes. In the postoperative period, 1 patient who had acute myocardial infarction died on the fourth postoperative day. The mean postoperative drainage duration of the patients was 5.5±1.9 (3 to 10) days and the mean length of hospital stay was 6.4±1.9 (4 to 11) days. When the pathologic features were examined, the mean tumor diameter was found to be 2.5±1.2 (1 to 5.5) cm. The mean follow-up period was calculated as 26.1±15.6 months (2 to 47). Other than 1 patient who died, the follow-up of 11 patients still proceeds. CONCLUSIONS VATS approach of sleeve resections, which is performed cautiously even by thoracotomy, is becoming more common. These operations, which could be performed in experienced centers, offer a postoperative period of less morbidity to the patients with the advantage of reduced postoperative pain, drainage time, and hospital stay.
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PREOPERATIVE ENDOBRONCHIAL SANITATION AS PREPARATION FOR THORACIC INTERVENTIONS. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim – to study the effectiveness of endoscopic photodynamic therapy as a preoperative preparation of the tracheobronchial tree in patients with lung cancer.
Materials and methods. The study included 181 patients with II-III stage of lung’s cancer. Diagnose of lung’s cancer was confirmed with a morphologically and concomitant endobronchitis. During the preoperative preparation, we used a technique developed by us introducing into the tracheobronchial tree an aqueous solution of brilliant green at concentration of 0.04 %, followed by irradiation of this solution with laser radiation with the wavelength of 0.63 μm (AFL-2 helium-neon laser) in an independent form and in combination with traditional anti-inflammatory therapy. Endoscopic endobronchial sanitation therapy was carried out by low-intensity radiation of the red part of the spectrum (λ=0.63–0.66 μm) in a pulsed mode, with a power of 12 mW.
Results. After 3–5 days of the start preoperative preparation and 1–2 sessions of endoscopic bronchosanation, the general state of patients was improved, the amount of sputum decreased and was changing from mucopurulent to mucous. To completely stop the clinical phenomena of endobronchitis, it was necessary to conduct 5-6 sessions of endoscopic photodynamic therapy according to our methodology, with the introduction of our method. In patients without pronounced clinical symptoms of concomitant chronic bronchitis, it was enough to complete only 3 sessions of bronchosanation.
Conclusion. Endoscopic photodynamic bronchosanation in the preoperative period in patients for correcting accompanying endobronchitis can significantly reduce or completely stop the clinical manifestations of endobronchitis in the shortest time and leads to a significant decrease in the number of endobronchial complications in surgical and combined treatment of lung cancer.
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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: 15] [Impact Index Per Article: 3.0] [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.
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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
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Park S, Kim Y, Yoon WS, Rim CH. A preliminary experience of moderate-intensity stereotactic body radiation therapy for ultra-central lung tumor. Int J Radiat Biol 2019; 95:1287-1294. [PMID: 31145016 DOI: 10.1080/09553002.2019.1626026] [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] [Indexed: 12/25/2022]
Abstract
Purpose: Administration of stereotactic body radiation therapy (SBRT) to ultra-central (UC) lung tumors, generally defined as those abutting the proximal bronchial trees, is difficult due to concerns about serious toxicities. Therefore, our institution has performed moderate-intensity SBRT. Patients and methods: Patients with UC tumors underwent SBRT at a dose of 50-60 Gy in 10 fractions, with Dmax in the target volume not exceeding 110% of the prescribed dose. The primary outcomes were tumor response and overall survival (OS). Results: From January 2017 to September 2018, we treated eight patients who had been diagnosed with UC tumors. The median follow-up time was 8.6 months (range: 2.7-14.9). Five of the eight patients (62.5%) showed a complete response (CR), two (25%) had a partial response (PR), and one (12.5%) had stable disease (SD); the response and disease control rates were 87.5% and 100%, respectively. Seven patients were alive with no evidence of disease or with controlled disease until the last follow-ups, except for one patient who died due to a non-RT cause at 3 months after SBRT. One patient experienced grade 2 esophageal pain and another had grade 1 cough. No grade 3 or higher toxicities were reported. Conclusion: Moderate-intensity SBRT might aid in achieving good control of UC tumors without excessive toxicities. Future studies involving larger numbers of patients and longer follow-up times are warranted to confirm the efficacy and feasibility.
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Affiliation(s)
- Sunmin Park
- Department of Radiation Oncology, Korea University Ansan Hospital , Ansan , Republic of Korea
| | - Young Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Ansan Hospital, Korea University Medical College , Ansan , Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital , Ansan , Republic of Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital , Ansan , Republic of Korea
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Wang W, Men Y, Wang J, Zhou Z, Chen D, Xiao Z, Feng Q, Lv J, Liang J, Bi N, Gao S, Wang L, Hui Z. Postoperative radiotherapy is effective in improving survival of patients with stage pIII-N2 non-small-cell lung Cancer after pneumonectomy. BMC Cancer 2019; 19:478. [PMID: 31113432 PMCID: PMC6530017 DOI: 10.1186/s12885-019-5692-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
Background There were few reports of postoperative radiotherapy (PORT) in stage pIII-N2 Non-small-cell Lung Cancer (NSCLC) patients receiving pneumonectomy followed by adjuvant chemotherapy. This study aims to evaluate safety and efficacy of PORT among these patients. Methods Between Jan. 2004 and Dec. 2015, stage pIII-N2 NSCLC patients receiving pneumonectomy and adjuvant chemotherapy with or without PORT in our institution were retrospectively reviewed. Results Totally 119 patients were included, 32 patients receiving adjuvant chemotherapy and PORT (PORT group) and 87 receiving adjuvant chemotherapy alone (Control group). There were more patients with non-R0 resection in PORT group than Control group (25% vs. 8%, p = 0.031). In PORT group, ≥Grade 2 radiation-induced pneumonitis was 2/32. No severe radiation-related heart injury was observed. There was no PORT-related death. Of all patients, median follow-up time was 25 months. Median overall survival time (mOS) and median disease-free survival time (mDFS) were 46 months and 15 months, respectively. The PORT group had significantly better OS (not reached vs. 34 months, p = 0.003), DFS (19 months vs. 13 months, p = 0.024), local recurrence free survival (LRFS, p = 0.012), and distant metastasis free survival (DMFS, p = 0.047) than the Control group. As for failure pattern, PORT significantly reduced local regional failure rate (39.1% vs. 15.6%, p = 0.016). In subgroup analysis, patients with R0 resection (n = 104), OS and LRFS in PORT group were significantly longer, and PORT tended to increase DFS and DMFS. Conclusion For patients with stage pIII-N2 NSCLC after pneumonectomy and adjuvant chemotherapy, PORT can improve OS, DFS, LRFS and DMFS with tolerable toxicity.
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Affiliation(s)
- Wenhui Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.,Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yu Men
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.,Department of VIP Medical Services, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli #17, Chaoyang District, Beijing, 100021, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. .,Department of VIP Medical Services, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli #17, Chaoyang District, Beijing, 100021, China.
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Rim CH, Kim Y, Kim CY, Yoon WS, Yang DS. Is stereotactic body radiotherapy for ultra-central lung tumor a feasible option? A systemic review and meta-analysis. Int J Radiat Biol 2019; 95:329-337. [PMID: 30676182 DOI: 10.1080/09553002.2019.1552375] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Ultra-central (UC) tumors, which are generally defined as tumors directly abutting the proximal bronchial tree, are difficult to treat with stereotactic body radiotherapy (SBRT) owing to possible serious complications. This systemic review and meta-analysis analyzed the early experiences and evaluated the efficacy and feasibility of SBRT for UC tumors. METHODS AND MATERIALS The present study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systemic searches of the EMBASE, PubMed, MEDLINE, and Cochrane library electronic databases were performed. The primary endpoints were two-year local control (LC), overall survival (OS), and grade ≥3 complication rates. A random-effects model was used to determine the pooled rates of the primary endpoints. Grade 5 complications were descriptively assessed. RESULTS Nine studies involving 291 patients with UC tumors who underwent SBRT were included. The pooled two-year LC, two-year OS, and grade ≥3 complication rates were 96.7% (95% confidence interval [CI]: 91.0-98.9), 57.7% (95% CI: 32.0-79.8), and 23.2% (95% CI: 11.8-40.5), respectively. The incidence of grade 5 complication was 0-22% and was 0% in three of eight available studies. Hemorrhage (68.2%) was the commonest fatal complication. The risk factors for fatal hemoptysis included anticoagulant use, excessive maximum irradiation dose, endobronchial involvement, squamous histology, and bevacizumab exposure. CONCLUSIONS SBRT for UC tumors confers efficient LC, although the risk of complications was not negligible. Control of possible risk factors of hemorrhage and dose optimization through further studies are warranted.
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Affiliation(s)
- Chai Hong Rim
- a Department of Radiation Oncology , Ansan Hospital Korea University Medical College , Ansan , Republic of Korea
| | - Young Kim
- b Division of Pulmonary Sleep and Critical Care Medicine, Department of Internal Medicine , Ansan Hospital Korea University Medical College , Ansan , Republic of Korea
| | - Chul Yong Kim
- c Department of Radiation Oncology , Anam Hospital Korea University Medical College , Seoul , Republic of Korea
| | - Won Sup Yoon
- a Department of Radiation Oncology , Ansan Hospital Korea University Medical College , Ansan , Republic of Korea
| | - Dae Sik Yang
- d Department of Radiation Oncology , Guro Hospital Korea University Medical College , Seoul , Republic of Korea
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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
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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: 3] [Impact Index Per Article: 0.5] [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.
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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
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Baisi A, Raveglia F, De Simone M, Cioffi U. Could Tumor Stage Be Conditioned by Surgical Technique Adopted? Ann Thorac Surg 2017; 104:1100-1101. [PMID: 28838499 DOI: 10.1016/j.athoracsur.2016.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Alessandro Baisi
- Department of Surgery, University of Milan, Ospedale San Paolo, Via Di Rudinì 8, 20142 Milan, Italy.
| | - Federico Raveglia
- Department of Surgery, University of Milan, Ospedale San Paolo, Via Di Rudinì 8, 20142 Milan, Italy
| | - Matilde De Simone
- Department of Surgery, University of Milan, Ospedale San Paolo, Via Di Rudinì 8, 20142 Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Ospedale San Paolo, Via Di Rudinì 8, 20142 Milan, Italy
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Plenzig S, Soriano M, Held H, Verhoff MA. Post-operative fatal blood aspiration after routine lung surgery. Forensic Sci Int 2017; 277:e11-e15. [PMID: 28592376 DOI: 10.1016/j.forsciint.2017.05.017] [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: 04/05/2017] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 11/30/2022]
Abstract
A routine question encountered in medicolegal practice is whether the death of a patient in proximity to a surgical procedure is due to medical malpractice. The case of a 62-year-old man who died two weeks after undergoing a VATS sleeve resection of the upper right lung lobe in conjunction with radical lymphadenectomy, a routine surgical procedure, is reported. To address the issue of medical malpractice, a forensic autopsy was ordered by the investigative authority. During the autopsy, the lungs were removed as a whole and fixed in formalin and were later dissected in cooperation with a thoracic surgeon. In the course of this dissection, a bronchovascular fistula, which had led to the occlusion of the bronchial system with clotted blood, was discovered. Bronchovascular fistulas are a rare complication of bronchial sleeve resections. Because this surgical complication is essentially always fatal, it is highly pertinent to medicolegal practice. The presented case report also lists other important complications associated with bronchial anastomosis and elucidates a pragmatic approach to obtaining an expert clinical assessment of possible medical malpractice after operations through the example of a dissection performed in cooperation with a thoracic surgeon.
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Affiliation(s)
- Stefanie Plenzig
- University Hospital Frankfurt, Institute of Legal Medicine, Kennedyallee 104, 60596 Frankfurt am Main, Germany.
| | - Mauricio Soriano
- University Hospital Frankfurt, Department of Cardiac, Thoracic and Cardiovascular Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Hannelore Held
- University Hospital Frankfurt, Institute of Legal Medicine, Kennedyallee 104, 60596 Frankfurt am Main, Germany
| | - Marcel A Verhoff
- University Hospital Frankfurt, Institute of Legal Medicine, Kennedyallee 104, 60596 Frankfurt am Main, Germany
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