Novosti
|
This journal is indexed in Scopus |
|---|
Year 2012 Vol. 20 No 3
ONCOLOGY
V.V. ZHARKOV, S.A. YESKOV, V.P. KURCHIN
THE LEFT ATRIUM RESECTION IN PATIENTS WITH LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER
SE “N.N.Alexandrov Republican scientific practical center of oncology and radiology”, Minsk
The Republic of Belarus
Objectives. To evaluate the surgical method efficacy while treating patients with non-small cell lung cancer (NSCLC) extending to the intrapericardial sections of the pulmonary veins and/or the left atrium (LA).
Methods. The result analysis of the surgical treatment of 55 patients with locally advanced NSCLC requiring LA resection was carried out in this research. The average age made up 58,4 years (from 38 up to 77 years), median was 59 years. The process was staged as T3N1M0 in 2 cases, as T3N2M0 – in 4 cases, T4N0M0 – in 5 cases, T4N1M0 – in 18 cases, T4N2M0 – in 26 cases. According to the histological structure of the tumor, the patients were divided as follows: the squamous cell carcinoma – 48 (87,3%), adenocarcinoma – (7,3%), the adenosquamous carcinoma – 2, the undifferentiated large cell carcinoma – 1. LA myocardium lesion was noted in 21 cases (38,2%), in the intrapericardial sections of the pulmonary veins – in 34 cases (61,8%). The LA resection was carried out with the help of the linear suturing apparatus in 43 cases, in 2 cases – with vascular clamp. In 10 patients LA resection and its plasty with xenopericardium was done under the conditions of the artificial blood circulation (ABC).
Results. Incidence of the postoperative complications made up 32,7%, postoperative lethality – 10,9%. One-year, three-year and five-year survival rates (n=55) made up 60,9%, 43,3% and 25,1% correspondently, survival rate median – 18,3 months. Among the patients (n=49) with the tumor, classified as pT4N0-2M0, – 62,4%, 33,4% and 27,8% correspondently, survival rate median – 18,3 months. In patients with metastatic lesions of the mediastinal lymph nodes (pT4N2M0, n = 26) five-year survival rate was 29,2%, survival rate median – 18,9 months without mediastinal lymph nodes lesions T4N0-N1 (n = 22) – 21,2% and 16,0 months correspondently (p=0,55).
Conclusions. Surgical method of treatment in patients with NSCLC extending to the heart structures can ensure high long-term survival rate at acceptable frequency parameters of the postoperative complications and postoperative lethality.
1. Pitz CC, Brutel de la Riviere 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.
2. Tsuchiya R, Asamura H, Kondo H, Goya T, Naruke T. Extended resection of the left atrium, great vessels, or both for lung cancer. Ann Thorac Surg. 1994 Apr;57(4):960–65.
3.Trakhtenberg AKh, Chissov VI. Klinicheskaia onkopul'monologiia [Clinical oncopulmonology]. Moscow, RF: GEOTAR Meditsina, 2000. 600 p.
4.Borri A, Leo F, Veronesi G, Solli P, Galetta D, Gasparri R, Petrella F, Scanagatta P, Radice D, Spaggiari L. Extended pneumonectomy for non-small cell lung cancer: morbidity, mortality, and long-term results. J Thorac Cardiovasc Surg. 2007 Nov;134(5):1266–72.
5. Akopov AL, Mosin IV, Gorbunkov SD, Agishev AS, Filippov DI, Ramazanov RR, Speranskaia AA. Kombinirovannye rezektsii legkikh i stenki levogo predserdiia pri rake legkogo: 15-letnii opyt. [The combined resections of lungs and a wall of the left auricle in lung cancer: 15-year experience]. Onkol Zhurn. 2007;1(2):8–20.
6. Ratto GB, Costa R, Vassallo G, Alloisio A, Maineri P, Bruzzi P. Twelve-year experience with left atrial resection in the treatment of non-small cell lung cancer. Ann Thorac Surg. 2004 Jul;78(1):234–37.
7. Doddoli C, Rollet G, Thomas P, Ghez O, Seree Y, Giudicelli R, Fuentes P. Is lung cancer surgery justified in patients with direct mediastinal invasion? Eur J Cardiothorac Surg. 2001 Aug;20(2):339–43.
8. Spaggiari L, D' Aiuto M, Veronesi G, Pelosi G, de Pas T, Catalano G, de Braud F. Extended pneumonectomy with partial resection of the left atrium, without ñardiopulmonary bypass, for lung cancer. Ann Thorac Surg. 2005 Jan;79(1):234–40.
9. Filaire M, Nohra O, Sakka L, Chadeyras JB, Da Costa V, Naamee A, Bailly P, Escande G. Anatomical bases of the surgical dissection of the interatrial septum: a morphological and histological study. Surg Radiol Anat. 2008 Jun;30(4):369–73.
10. Shimizu J, Hirano Y, Ishida Y, Kinoshita S, Tatsuzawa Y, Kawaura Y, Takahashi S.Advanced lung cancer invading the left atrium wall treated with pneumonectomy and combined resection of the left atrium using stapling devices: report of two cases. Ann Thorac Cardiovasc Surg. 2004 Apr;10(2):113–17.
11. Ferguson JrE, Reardon MJ. Atrial resection in advanced lung carcinoma under total cardiopulmonary bypass. Tex Heart Inst J. 2000;27(2):110–12.
12.Loscertales J, Jimenez-Merchan R, Congregado-Loscertales M, Arenas-Linares C, Giron-Arjona JC, Tristan AA, Ayarra J. Usefulness of video thoracoscopic intrapericardial examination of pulmonary vessels to identify respectable clinical T4 lung cancer. Ann Thorac Surg. 2002 May;73(5):1563–66.
13. Eggeling S, Martin T, Bottger J, Beinert T, Gellert K. Invasive staging of non-small cell lung cancer – a prospective study. Europ. J Card Thor Surg. 2002;22:679–84.
14. Gielda BT, Marsh JC, Zusag TW, Faber LP, Liptay M, Basu S, Warren WH, Fidler MJ, Batus M, Abrams RA, Bonomi P. 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.
15. Jalal SI, Riggs HD, Melnyk A, Richards D, Agarwala A, Neubauer M, Ansari R, Govindan R, Bruetman D, Fisher W, Breen T, Johnson CS, Yu M, Einhorn L, Hanna N. Updated survival and outcomes for older adults with inoperable stage III non-small-cell lung cancer treated with cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel: analysis of a phase III trial from the Hoosier Oncology Group (HOG) and US Oncology. Ann Oncol. 2012 Jul;23(7):1730–38.
16. Takeuchi K, Katsumoto K, Niibori T, Yamamoto K, Okuno T. Simultaneous resection of the left atrium for lung neoplasms. Nihon Kyobu Geka Gakkai Zasshi. 1983 Sep;31(9):1448–54. [Article in Japanese]
17.Shirakusa T, Kimura M. Partial atrial resection in advanced lung carcinoma with and without cardiopulmonary bypass. Thorax. 1991;46(10):484-87.
18.Wahba A. Liebold A, Birnbaum DE. Recurrent malignant fibrous histiocytoma of the left atrium in a 27- year-old male. Europ J Cardio-Thor Surg. 1993;7(7):387–89.
19. Baron O, Jouan J, Sagan C, Despins P, Michaud JL, Duveau D. Resection of bronchopulmonary cancers invading the left atrium - benefit of cardiopulmonary bypass. Thorac Cardiovasc Surg. 2003 Jun;51(3):159–61.
20. Toyooka S, Mori H, Kiura K, Date H. Induction chemoradiotherapy prior to surgery for non-small cell lung cancer invading the left atrium. Europ J Cardio-Thor Surg. 2008 Feb;33(2):315–16.
21. Hasegawa S, Bando T, Isowa N, Otake Y, Yanagihara K, Tanaka F, Inui K, Wada H. The use of cardiopulmonary bypass during extended resection of non-small cell lung cancer. Inter Cardio Vasc Thor Surg. 2003 Dec;2(4):676–79.
22. Byrne JG, Leacche M, Agnihotri AK, Paul S, Bueno R, Mathisen DJ, Sugarbaker DJ. The use of cardiopulmonary bypass during resection of locally advanced thoracic malignancies: a 10-year two-center experience. Chest. 2004 Apr;125(4):1581–86.
23. Bobbio A, Carbognani P, Grapeggia M, Rusca M, Sartori F, Bobbio P, Rea F. Surgical outcome of combined pulmonary and atrial resection for lung cancer. Thorac Cardiovasc Surg. 2004 Jun;52(3):180–82.
24. Fukuse T, Wada H, Hitomi S. Extended operation for non-small cell lung cancer invading great vessels and left atrium. Europ J Cardio Thor Surg. 1997;11:664–69.
223040, Respublika Belarus', Minskii r-n, p. Lesnoi, 2, GU “RNPTs onkologii i meditsinskoi radiologii im. N.N. Aleksandrova“, otdel torakal'noi onkopatologii s gruppoi anesteziologii,
e-mail: 445e@mail.ru,
Eskov Sergey Aleksandrovich
Zharkov V.V. Doctor of Medical Sciences, Professor, Chief Research Fellow of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Yeskov S.A., a Research Fellow of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Kurchin V.P., Doctor of Medical Sciences, Head of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Article in the .pdf format
