The impact on quality of life after en‐bloc resection for non‐small‐cell lung cancer involving the chest wall

Abstract

Background: En‐bloc resection for non‐small cell lung cancer with chest‐wall involvement may achieve a 5‐year survival rate higher than 40%, but the impact on postoperative quality of life is not yet known. Methods: Twenty‐six patients undergoing en‐bloc lung resections were included. Life quality ratings were assessed through a Short‐Form 36 questionnaire preoperatively and at six, 12, 18 and 24 month follow‐up visits. The degree of dyspnea, pain level, and flow‐volume curves were also obtained at the same time periods. Changes occurring over time were analyzed by means of repeated‐measure ANOVA. Results: As a whole, the Physical Component Summary score declined six months postoperatively (P < 0.0001) and failed to improve thereafter. Patients with preoperative Forced Expiratory Volume in one second (FEV1), <80% predicted (P = 0.029), resected ribs >2 (P = 0.03), and chest wall defect ≥50 cm2 (P = 0.007) experienced a greater and lasting impairment. Net postoperative decrease in FVC (P = 0.02; r = 0.48) and dyspnea worsening (P = 0.03; r =−043 at six months, P = 0.05; r =−0.39 at 12 months) were also correlated with the extent of physical deterioration, whereas age (P = 0.92), gender (P = 0.51), type of resection (P = 0.71), and adjuvant therapy (P = 0.68) did not. The Physical Component Summary didn't change significantly in patients with high pain levels (VAS >7). The Mental Component Summary score increased slightly at six months, with no difference in any patients' subgroup. Conclusions: The extent of chest wall resection, preoperative FEV1, and postoperative decline in FVC were the main indicators of quality of life impairment after en‐bloc resection for lung cancer. The impact upon quality of life should be considered in a cost‐to‐benefit ratio of planning this surgery in suboptimal candidates.

Health-related quality of life after oncological resection and reconstruction of the chest wall

“…Heuker et al did not report in their study ( n = 23) whether patients had undergone oncological adjuvant treatment, which can have an impact on HRQoL. Tacconi et al 12 discovered that the extent of chest wall resection, preoperative forced expiratory volume, and postoperative decline in forced vital capacity were the main indicators for decline in HRQoL as measured by the SF-36. Decline of HRQoL was correlated with the extent of surgical trauma.…”

“…The sample size is comparable favorably with that of previous studies. [9][10][11][12][13] The response rate (71%) can also be considered acceptable. In our study, we report the extent of surgical operation, need for reconstruction, method of reconstruction, and patient's diagnosis.…”

“…7 Few previous studies assessing HRQoL in patients after chest wall tumor resection all have some limitations. [8][9][10][11][12] They are hampered by small sample size 8,9,11,12 ; fail to compare results obtained in patients to those of a healthy control population 8 , 10-12 ; or do not report the extent of the surgical operations, need for reconstruction, and methods of reconstruction. 9,10 There are no studies assessing postoperative HRQoL of patients with chest wall sarcoma.…”

A case of parachordoma on the chest wall and literature review

“…The imaging manifestation has a non-specific appearance. [11] Macroscopic examination of parachordoma reveals that the tumor has a lobulated or nodular appearance. The tumor has been reported a diameter range of 2-8 cm with a mean diameter of 3.5 cm.…”

Combined pulmonary lobectomy for surgical treatment of a malignant fibrous histiocytoma of the chest wall: a case report

“…Favorable factors for MFHs are: UICC/AJCC stage I and II, superficial location, myxoid type, and patient under 50 years of age. Under these conditions, the rational for radical en-block resection of the tumor is supported [ 6 - 10 ].…”