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Extended operation for T4 lung carcinoma
T Shirakusa1, K Kawahara, A Iwasaki
1Second Department of Surgery, School of Medicine, Fukuoka University, Nanakuma 7-45-1 Jonanku, Fukuoka 814-0180, Japan.
Summary
Extended surgery for T4 lung carcinoma shows improved survival rates. Advances in perioperative care and chemotherapy offer better prognoses, especially for specific organ involvements and tumor types.
Area of Science:
- Thoracic Surgery
- Oncology
- Pulmonary Medicine
Background:
- T4 lung carcinoma historically has a poor prognosis with 5-year survival rates under 10%.
- Recent advancements in perioperative intensive care and induction chemotherapy offer potential for improved outcomes.
Purpose of the Study:
- To compare surgical outcomes for T4 lung carcinoma between two distinct time periods.
- To identify prognostic factors influencing survival in patients undergoing extended surgery for T4 lung carcinoma.
Main Methods:
- Retrospective review of surgical cases for T4 lung carcinoma.
- Comparison of survival rates (3-year and 5-year) between 1978-1989 and 1992-1997 cohorts.
- Analysis of prognostic factors including involved organs, lymph node status (N stage), and histology.
Main Results:
- 3-year survival increased from 6.8% (1978-1989) to 24.6% (1992-1997).
- Combined resection of trachea, carina, aorta, and left atrium showed better prognoses than involvement of esophagus or liver.
- Median survival time (MST) for T4 with N0/N1 was 25.5 months versus 14.2 months for N2/N3.
- Squamous cell carcinoma demonstrated a better prognosis than adenocarcinoma.
Conclusions:
- Extended surgery for T4 lung carcinoma has a more favorable prognosis in the modern era due to improved perioperative care and chemotherapy.
- Prognosis is significantly influenced by the extent of local invasion, lymph node metastasis, and histological subtype.
- Malignant pleural effusion with N2 disease is not considered a candidate for panpleuropneumonectomy.