Surgical management of lung cancer invading the aorta or the superior vena cava

Misthos, Panagiotis; Papagiannakis, George; Kokotsakis, John; Lazopoulos, George; Skouteli, Eleni Anna T.; Lioulias, Achilleas

doi:10.1016/j.lungcan.2006.12.008

Cited by 61 publications

(42 citation statements)

References 20 publications

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“…5,7) On the other hand, Suzuki, et al found a significant difference in survival between patients with superior vena cava invasion by metastatic lymph nodes as compared to direct tumor extension, 8) whereas others have noted that patients with pN0 status had a good prognosis. 9) In the present study, some c/cyN0 or pN0 status patients were long-term survivors after combined resection of a great vessel, while outcome was poor in patients with c/cyN1-2 or pN1-2 status or those with lymph node invasion to a great vessel. Although there was no significant difference between patients who did and did not obtain down-staging by induction therapy, patients down-staged from cN2-3 to ycN0 had no recurrence, thus long-time survival is possible in patients who achieve ycN0 status by induction therapy.…”

Section: Discussionmentioning

confidence: 43%

Combined Resection of Great Vessels or the Heart for Non-Small Lung Cancer

Kusumoto

Shintani

Funaki

et al. 2015

ATCS

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Objectives: The surgical indications for non-small cell lung cancer (NSCLC) infiltrating a great vessel or the heart are controversial. We assessed clinical features and surgical outcomes of patients with non-small cell lung cancer who underwent combined resection of a lung and great vessel. Methods: Fourteen patients underwent great vessel resection under a lobectomy (n = 9), sleeve lobectomy (n = 2), or pneumonectomy (n = 3) between 2000 and 2011, in whom the aorta was resected in 6, superior vena cava in 5, right atrium in 1, and left atrium in 2. The histological types were adenocarcinoma (n = 8) and squamous cell carcinoma (n = 6). Results: Complete resection was performed in 12 patients. Of all patients, 7 had pN0 disease, 2 had pN1, and 4 had pN2. The postoperative morbidity rate was 28.6% and mortality rate was 7.1%. The 5-year survival rate was 26.8% for all patients, 46.9% for those with an adenocarcinoma, 0% for those with a squamous cell carcinoma, 53.6% for those with pN0, and 0% for those with pN1-2. Conclusion: Resection of the great vessels and heart involved by NSCLC can be performed with acceptable morbidity and mortality, and results in prolonged survival in patients, with an adenocarcinoma or N0 status.

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Section: Discussionmentioning

confidence: 43%

Combined Resection of Great Vessels or the Heart for Non-Small Lung Cancer

Kusumoto

Shintani

Funaki

et al. 2015

ATCS

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“…62,64,66,67 In general, the studies reporting higher 5-year OS tend to have lower proportion of patients with N1 or N2 disease. 62,64,66,67 Although resecting lung cancers with significant aortic involvement has traditionally required cardiopulmonary bypass, recent work has shown that these resections can be accomplished with the use of thoracic endovascular stent grafts thereby obviating the need for bypass. 68 These are all retrospective studies and have inherent selection bias.…”

Section: Great Vessel Invasionmentioning

confidence: 98%

“…Sample sizes range from 8 to 109 patients with SVC invasion in whom lung and SVC resection with repair/reconstruction has resulted in 5-year OS ranging from 11% to 29%. [61][62][63][64] The majority of studies report a 5-year OS rate of approximately 20%. [61][62][63] Pulmonary vessel invasion requiring en-bloc resection with repair/reconstruction has also been reported to have survival of approximately 20%.…”

Section: Great Vessel Invasionmentioning

confidence: 99%

MDT lung cancer care: Input from the Surgical Oncologist

2015

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Although there have been many advancements in the multidisciplinary management of non-small cell lung cancer (NSCLC), surgery remains the primary modality of choice for resectable lung cancer when the patient is able to tolerate lung resection physiologically. There have been recent advances in surgical diagnosis and treatment of lung cancer. Increasing use of low-dose computed tomography (CT) screening for lung cancer has resulted in increased detection of small peripheral nodules or semi-solid ground glass opacities. Here, we review different modalities of localization techniques that have been used to aid surgical excisional biopsy when needle biopsy has failed to provide tissue diagnosis. We also report on the current debates regarding the use of sublobar resections for Stage I NSCLC as well as the surgical management of locally advanced NSCLC. Finally, we discuss the complex surgical management of T4 NSCLC lung cancers.

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“…In a small series (n=13) from the era before the adoption of endovascular stents, Misthos et al observed tumor invading the aortic adventitia only in 69% of cases (36). Importantly, only 8% of patients had pathologic N0 disease, and unexpected N2 disease was found in 31% of patients.…”

Section: Aortic Involvementmentioning

confidence: 99%

Initial extended resection or neoadjuvant therapy for T4 non-small cell lung cancer—what is the evidence?

Ilonen

Jones

2018

Shanghai Chest

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Locally advanced non-small cell lung cancer (NSCLC) tumors that invade surrounding structures within the chest (T4) are a heterogeneous group, and, as such, there are no straightforward guidelines for their management. Advances in imaging, invasive mediastinal staging, and neoadjuvant therapies have expanded the role of surgery with curative intent for this patient group and have also diminished the rate of explorative thoracotomies. Unlike for T4 superior sulcus tumors, the use of neoadjuvant therapy for central T4 tumors is not clearly defined. The most important determinants of a successful outcome after surgery are achieving an R0 resection and avoiding incidental pathologic N2 disease. Use of neoadjuvant therapy in this setting may yield better outcomes after surgery, as both of these variables can be altered if the tumor responds to neoadjuvant therapy. Moreover, response to induction therapy has been shown to have prognostic value.

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Surgical management of lung cancer invading the aorta or the superior vena cava

Cited by 61 publications

References 20 publications

Combined Resection of Great Vessels or the Heart for Non-Small Lung Cancer

Combined Resection of Great Vessels or the Heart for Non-Small Lung Cancer

MDT lung cancer care: Input from the Surgical Oncologist

Initial extended resection or neoadjuvant therapy for T4 non-small cell lung cancer—what is the evidence?

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