Surgical Treatment for T4 Non-small Cell Lung Cancer Invading Mediastinal Structures / 대한흉부외과학회지
The Korean Journal of Thoracic and Cardiovascular Surgery
;
: 349-355, 2004.
Article
in Korean
| WPRIM
| ID: wpr-219233
ABSTRACT
BACKGROUND:
Non-small cell lung cancer (NSCLC) with invasion of mediastinal structures is classified as stage IIIB, and has been considered surgically unresectable. However, in a selected group of these patients, better results after surgical resection compared to non-surgical group have been reported. The aim of this study is to evaluate the role of surgical resection in treatment of mediastinal T4 NSCLC. MATERIAL ANDMETHOD:
Among 1067 patients who underwent surgical intervention for non-small cell lung cancer from Aug 1987 to Dec 2001 in Korea cancer center hospital, 82 patients had an invasion of T4 mediastinal structures (7.7%). Resection was possible in 63 patients (63/82 resectability 76.8%). Their medical records in Data Base were reviewed, and they were followed up completely until Jun 2002. Surgical results and prognostic factors of NSCLC invading mediastinal structures were evaluated retrospectively.RESULT:
Lung cancer was resected completely in 52 patients (63.4%, 52/82). Lung resection was lobectomy (or more) in 14, pneumonectomy in 49. The mediastinal structures invaded by primary tumor were great vessel (61.9%), heart (19%), vagus nerve (9.5%), esophagus (7.9%), and vertebral body (7.9%). Nodal status was N0 in 11, N1 in 24, and N2 in 28 (44.4%). Neoadjuvant therapy was done in 6 (9.5%, 5 chemotherapy, 1 radiotherapy), and adjuvant therapy was added in 44 (69.8%, 15 chemotherapy, 29 radiotherapy) in resection group (n=63). Complication was occurred in 23 (31.7%), and operative mortality was 9.5% in resection group. Median and 5 year overall survival including operative mortality was 18.1 months and 21.7% in resection group (n=63), 6.2months and 0 % in exploration only group (n=19, p=.001), 39 months and 32.9% in N2 (-) resection group (n=35), and 8.8 months and 8.6% in N2 (+) resection group (n=28, p=.007). The difference of overall survival by mediastinal structure was not significant.CONCLUSION:
The operative risk of NSCLC invading mediastinal structures was high but acceptable, and long-term result of resection was favorable in selected group. Aggressive resection is recommended in well selected pateints with good performace and especially N2 (-) NSCLC with mediastinal invasion.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Pneumonectomy
/
Vagus Nerve
/
Medical Records
/
Retrospective Studies
/
Mortality
/
Carcinoma, Non-Small-Cell Lung
/
Neoadjuvant Therapy
/
Drug Therapy
/
Esophagus
/
Heart
Type of study:
Observational study
/
Prognostic study
Limits:
Humans
Country/Region as subject:
Asia
Language:
Korean
Journal:
The Korean Journal of Thoracic and Cardiovascular Surgery
Year:
2004
Type:
Article
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