This journal is
indexed in Scopus
Year 2016 Vol. 24 No 4
V.V. ZHARKOV 1, S.A. YESKOV 2, V.V. EROKHOV 2
SURGICAL TREATMENT RESULTS OF PATIENTS WITH LOCALLY ADVANCED (PT4) NON-SMALL CELL LUNG CANCER
SE "Republican Scientific-Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov"1,
ME "The 9th City Clinical Hospital"2,
The Republic of Belarus
Objectives. To evaluate the immediate and long-term results of surgical treatment of patients with locally advanced non-small cell lung cancer (NSCLC – stage IIIA-IIIB) accompanied by mediastinal invasion of the tumor.
Methods. 180 surgeries had been performed (1996-2012 yrs) to the patients with locally advanced pT4 NSCLC. The age varied from 21 up to 81, the median age – 58. The right-sided tumor was registered in 103 cases and left-sided – in 77. The pT4 descriptor was determined on the basis of the lung cancer invasion of different structures or mediastinal organs. Affection of two or more structures occurred in 77 cases. The disease was staged as pT4N0M0 in 23 cases, pT4N1M0 – in 54, pT4N2M0 – in 103. Surgical interventions such as combined lobectomy or bilobectomy were performed only in 5 patients, and combined pneumonectomy – in 175, including 34 cases – the carinal wedge resection of tracheal bifurcation and 42 – sleeve resection. Resection of the vena cava superior was performed in 36 patients. The aorta was resected in 27 cases, the left atrium – in 70, the esophagus – in 31, the vertebrae – in 8 patients; ribs were resected in 18 cases.
Results. The postoperative morbidity was 33,9%, mortality – 17,8%. Overall five-year survival rate of patients with stages IIIA-IIIB (pT4N0-2M0) was 19,8%, median survival – 14,9 months. In the group of IIIA (pT4N0-1M0) stage – 26,0%, 22,7 months, respectively. In the group of patients with metastatic mediastinal lymph nodes (pT4N2M0) – 14,7%, 13,6 months, respectively (p=0,038).
Conclusion. Combined surgery allows achieving satisfactory immediate and long-term results of treatment at the admissible indices of postoperative mortality. The best results can be obtained for patients with stage IIIA (pT4N0-1M0) NSCLC.
- Okeanov AE, Moiseev PI, Levin LF. Statistika onkologicheskikh zabolevanii v Respublike Belarus' [Statistics of oncologic diseases in Belarus]. Minsk, RB; 2014. 382 p.
- McPhail S, Johnson S, Greenberg D, Peake M, Rous B. Stage at diagnosis and early mortality from cancer in England. Br J Cancer. 2015 Mar 31;112(Is s1):S108-S115. doi:10.1038/bjc.2015.49.
- Kolbanov KI, Trakhtenberg AKh, Pikin OV, Riabov AB, Glushko VA. Khirurgicheskoe lechenie bol'nykh rezektabel'nym nemelkokletochnym rakom legkogo [Surgical treatment of patients with respectable NSCLC]. Issledovaniia i Praktika v Meditsine. 2014;1(1):16-23. doi: 10.17709/2409-2231-2014-1-1-16-23.
- Schuurman MS, Groen HJM, Pruim J, Janssen-Heijnen MLG, Pukkala E, Siesling S. Temporal trends and spatial variation in stage distribution of non-small cell lung cancer in the Netherlands. OA Epidemiology. 2014 Jul 18;2(1):10.
- Gonzalo Varela1 and Pascal Alexandre Thomas2 Surgical management of advanced non-small cell lung cancer. J Thorac Dis. 2014 May;6(Suppl 2):S217-S223. doi: 10.3978/j.issn.2072-1439.2014.04.34.
- Dartevelle PG. Herbert Sloan Lecture. Extended operations for the treatment of lung cancer. Ann Thorac Surg. 1997 Jan;63(1):12-9.
- Osaki T, Sugio K, Hanagiri T, Takenoyama M, Yamashita T, Sugaya M, et al. Survival and prognostic factors of surgically resected T4 non-small cell lung cancer. Ann Thorac Surg. 2003 Jun;75(6):1745-51; discussion 1751.
- Yildizeli B, Dartevelle PG, Fadel E, Mussot S, Chapelier A. Results of primary surgery with T4 non-small cell lung cancer during a 25-year period in a single center: the benefit is worth the risk. Ann Thorac Surg. 2008 Oct;86(4):1065-75; discussion 1074-5. doi: 10.1016/j.athoracsur.2008.07.004.
- Izbicki JR, Passlick B, Pantel K, Pichlmeier U, Hosch SB, Karg O, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg. 1998 Jan;227(1):138-44.
- Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest. 1997 Jun;111(6):1718-23.
- Spaggiari L, D' Aiuto M, Veronesi G, Pelosi G, de Pas T, Catalano G, et al. Extended pneumonectomy with partial resection of the left atrium, without cardiopulmonary bypass, for lung cancer. Ann Thorac Surg. 2005 Jan;79(1):234-40.
- Es'kov S, Zharkov V. Khirurgicheskaia tekhnika rezektsii levogo predserdiia pri rake legkogo [Surgical technique of resection of the left atrium in lung cancer]. Onkol Zhurn. 2012;6(2):35-41.
- Mountain CF. Revisions in the international system for staging lung cancer. Chest. 1997 Jun;111(6):1710-17.
- Pitz CC, Brutel de la Rivière A, van Swieten HA, Westermann CJ, Lammers JW, van den Bosch JM. Results of surgical treatment of T4 non-small cell lung cancer. Eur J Cardiothorac Surg. 2003 Dec;24(6):1013-18.
- Gielda BT, Marsh JC, Zusag TW, Faber LP, Liptay M, Basu S, et al. Split-course chemoradiotherapy for locally advanced non-small cell lung cancer: a single-institution experience of 144 patients. J Thorac Oncol. 2011 Jun;6(6):1079-86. doi: 10.1097/JTO.0b013e3182199a7c.
- Mansour Z, Kochetkova EA, Santelmo N, Meyer P, Wihlm JM, Quoix E, et al. Risk factors for early mortality and morbidity after pneumonectomy: a reappraisal. Ann Thorac Surg. 2009 Dec;88(6):1737-43. doi: 10.1016/j.athoracsur.2009.07.016.
- Farjah F, Wood DE, Varghese TK Jr, Symons RG, Flum DR. Trends in the operative management and outcomes of T4 lung cancer. Ann Thorac Surg. 2008 Aug;86(2):368-74. doi: 10.1016/j.athoracsur.2008.04.090.
220116, Republic of Belarus, Minsk, Semashko st., 8, ME "9th
City Clinical Hospital", thoracic department.
Tel: 375 29 115-77-36
Yeskov Sergey Aleksandrovich
Zharkov V.V. MD, Professor, Head "Republican scientific-practical center of oncology and medical radiology named after N.N. Alexandrov", surgical department.
Yeskov S.A. Head, ME "The 9th city clinical hospital", thoracic department.
Erokhov V.V. Surgeon, ME "The 9th city clinical hospital", thoracic department.