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European Journal of Cardio-Thoracic Surgery, Vol 11, 664-669, Copyright © 1997 by European Association for Cardio-thoracic Surgery
T Fukuse, H Wada and S Hitomi
OBJECTIVE: We analyzed the results of surgical treatment in patients with
non-small cell lung cancer invading the great vessels (GV) and left atrium
(LA) by direct extension and without distant metastases. METHODS: From 1976
to 1993, 42 patients (37/male, 5/female) with lung cancer invading the GV
and LA were treated surgically, 13 had invasion of the superior vena cava
and innominate vein, 15 of the aorta and subclavian artery, and 14 of the
left atrium. In all 42 the diagnosis was confirmed by pathological
examination. Surgical resection included pneumonectomy (16 patients) and
lobectomy (26 patients). The histologic type was squamous cell carcinoma in
27 patients, adenocarcinoma in 12, and large cell carcinoma in 3.
Preoperatively, 13 patients were treated with radiation and chemotherapy.
Postoperatively, further treatment was given to 22 patients. All were
staged according to the international TNM staging system. Survival was
calculated by the Kaplan-Meler method. RESULTS: A total of 15 patients
underwent complete resection. Reliability of clinical N factor was 80%. The
overall survival was 17% at 3 years (median survival time (MST), 14
months). The operative mortality was 2.4%. Patients with lung cancer
invading GV (MST, 19 months) had significantly longer survival than did
those with cancer invading LA (MST, 10 months, P = 0.036). There were
significant prognostic differences between N0-1 and N2-3 (MST, 22 months;
MST, 9 months, respectively, P = 0.0013). Cox regression analysis
identified pathological N factor, completeness of resection, and pre- and
postoperative radiotherapy as important in affecting survival. CONCLUSIONS:
We conclude that patients with pathological N0-1 non-small cell lung cancer
invading great vessels can achieve long-term survival with adequate
surgical treatment.
ARTICLES
Extended operation for non-small cell lung cancer invading great vessels and left atrium
Department of Thoracic Surgery, Kyoto University, Japan.
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