Abstract
Background: Extended resections (ER) for lung cancer may improve survival in selected patients. However, analysis on large series is still lacking. We reviewed our experience to identify prognostic factors useful for patient selection. Methods: Between 1998 and 2010, 167 patients with involvement of one or more mediastinal organs underwent operations with the intent to perform ER. At thoracotomy, 42 patients (25%) were considered unresectable (explorative thoracotomy [ET]), and 125 (75%) underwent ER. The types of ER were superior vena cava in 43 patients (34.4%), carina in 33 (26.4%), combined with superior vena cava in 18 (14.4%), with the left atrium in 35 (28%), and with the aorta in 14 (11.2%). We excluded Pancoast tumors and vertebral resections. The minimum follow-up was 6 months. Kaplan-Meier method and log-rank test were used for statistical analysis of survival. Results: There were 136 men (81.4%), with mean age of 63 years (range, 36 to 81 years). Of the 167 patients, induction chemotherapy was administered in 119 (71.3%), including 34 ET patients (81%) and 85 ER patients (68%). Complete resection was achieved in 106 patients (84.8%). The overall 5-year survival was 23% (27% in ER and 13% in ET, p = 0.41). Overall 30-day mortality was 4.8% and morbidity was 34.1%. Factors affecting survival were complete resection (p <0.01), pStage 0-I-II disease (p <0.0007), and age younger than 60 years (p <0.01). Conclusions: ER for lung cancer invading mediastinal organs could improve long-term survival (46% at 5-years in pN0). The best surgical candidates are young patients without lymph nodes involvement who undergo radical resection. Multimodality treatment is suggested in case of mediastinal lymph node involvement.
| Original language | English |
|---|---|
| Pages (from-to) | 1717-1725 |
| Number of pages | 9 |
| Journal | Annals of Thoracic Surgery |
| Volume | 95 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - May 2013 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
Cite this
Survival after extended resection for mediastinal advanced lung cancer : Lessons learned on 167 consecutive cases. / Spaggiari, Lorenzo; Tessitore, Adele; Casiraghi, Monica; Guarize, Juliana; Solli, Piergiorgio; Borri, Alessandro; Gasparri, Roberto; Petrella, Francesco; Maisonneuve, Patrick; Galetta, Domenico.
In: Annals of Thoracic Surgery, Vol. 95, No. 5, 05.2013, p. 1717-1725.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Survival after extended resection for mediastinal advanced lung cancer
T2 - Lessons learned on 167 consecutive cases
AU - Spaggiari, Lorenzo
AU - Tessitore, Adele
AU - Casiraghi, Monica
AU - Guarize, Juliana
AU - Solli, Piergiorgio
AU - Borri, Alessandro
AU - Gasparri, Roberto
AU - Petrella, Francesco
AU - Maisonneuve, Patrick
AU - Galetta, Domenico
PY - 2013/5
Y1 - 2013/5
N2 - Background: Extended resections (ER) for lung cancer may improve survival in selected patients. However, analysis on large series is still lacking. We reviewed our experience to identify prognostic factors useful for patient selection. Methods: Between 1998 and 2010, 167 patients with involvement of one or more mediastinal organs underwent operations with the intent to perform ER. At thoracotomy, 42 patients (25%) were considered unresectable (explorative thoracotomy [ET]), and 125 (75%) underwent ER. The types of ER were superior vena cava in 43 patients (34.4%), carina in 33 (26.4%), combined with superior vena cava in 18 (14.4%), with the left atrium in 35 (28%), and with the aorta in 14 (11.2%). We excluded Pancoast tumors and vertebral resections. The minimum follow-up was 6 months. Kaplan-Meier method and log-rank test were used for statistical analysis of survival. Results: There were 136 men (81.4%), with mean age of 63 years (range, 36 to 81 years). Of the 167 patients, induction chemotherapy was administered in 119 (71.3%), including 34 ET patients (81%) and 85 ER patients (68%). Complete resection was achieved in 106 patients (84.8%). The overall 5-year survival was 23% (27% in ER and 13% in ET, p = 0.41). Overall 30-day mortality was 4.8% and morbidity was 34.1%. Factors affecting survival were complete resection (p <0.01), pStage 0-I-II disease (p <0.0007), and age younger than 60 years (p <0.01). Conclusions: ER for lung cancer invading mediastinal organs could improve long-term survival (46% at 5-years in pN0). The best surgical candidates are young patients without lymph nodes involvement who undergo radical resection. Multimodality treatment is suggested in case of mediastinal lymph node involvement.
AB - Background: Extended resections (ER) for lung cancer may improve survival in selected patients. However, analysis on large series is still lacking. We reviewed our experience to identify prognostic factors useful for patient selection. Methods: Between 1998 and 2010, 167 patients with involvement of one or more mediastinal organs underwent operations with the intent to perform ER. At thoracotomy, 42 patients (25%) were considered unresectable (explorative thoracotomy [ET]), and 125 (75%) underwent ER. The types of ER were superior vena cava in 43 patients (34.4%), carina in 33 (26.4%), combined with superior vena cava in 18 (14.4%), with the left atrium in 35 (28%), and with the aorta in 14 (11.2%). We excluded Pancoast tumors and vertebral resections. The minimum follow-up was 6 months. Kaplan-Meier method and log-rank test were used for statistical analysis of survival. Results: There were 136 men (81.4%), with mean age of 63 years (range, 36 to 81 years). Of the 167 patients, induction chemotherapy was administered in 119 (71.3%), including 34 ET patients (81%) and 85 ER patients (68%). Complete resection was achieved in 106 patients (84.8%). The overall 5-year survival was 23% (27% in ER and 13% in ET, p = 0.41). Overall 30-day mortality was 4.8% and morbidity was 34.1%. Factors affecting survival were complete resection (p <0.01), pStage 0-I-II disease (p <0.0007), and age younger than 60 years (p <0.01). Conclusions: ER for lung cancer invading mediastinal organs could improve long-term survival (46% at 5-years in pN0). The best surgical candidates are young patients without lymph nodes involvement who undergo radical resection. Multimodality treatment is suggested in case of mediastinal lymph node involvement.
UR - http://www.scopus.com/inward/record.url?scp=84876691096&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84876691096&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2013.01.088
DO - 10.1016/j.athoracsur.2013.01.088
M3 - Article
C2 - 23566644
AN - SCOPUS:84876691096
VL - 95
SP - 1717
EP - 1725
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 5
ER -