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Extended resection for lung cancer invading mediastinal organs
T Takahashi1, S Akamine, M Morinaga
1First Department of Surgery, Nagasaki University School of Medicine, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|September 25, 1999
Summary
Aggressive surgery for non-small-cell lung cancer invading mediastinal organs offers a 5-year survival of 18% for complete resections. Selectivity is crucial, as patients with N0/N1 node status and squamous cell carcinoma benefit most.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Non-small-cell lung cancer (NSCLC) invading mediastinal organs presents significant surgical challenges.
- Invasion of structures like the left atrium, superior vena cava, and aorta requires complex resection strategies.
Purpose of the Study:
- To evaluate the outcomes of aggressive surgical resection for NSCLC invading mediastinal organs.
- To identify factors influencing survival in these challenging cases.
Main Methods:
- Analysis of 49 patients with NSCLC invading mediastinal structures.
- Surgical procedures included lobectomy, pneumonectomy, and limited resections, with some requiring carina- or bronchoplasty.
- Outcomes assessed included operative mortality, overall survival, and factors affecting prognosis.
Main Results:
- Complete resection was achieved in 35 patients, with an operative mortality of 12% and a 5-year survival rate of 13%.
- Complete resection (18% 5-year survival) significantly improved outcomes compared to incomplete resection (0% survival).
- Favorable prognostic factors included squamous cell carcinoma (36% 5-year survival) and node-negative or N1 status (36% 5-year survival).
Conclusions:
- Aggressive resection for mediastinal NSCLC carries high mortality, necessitating careful patient selection.
- Complete resection, N0/N1 node status, and squamous cell histology are associated with the best surgical outcomes.
- Surgical intervention may benefit carefully selected patients with locally advanced NSCLC invading the mediastinum.