Results of Combined Resection of Adjacent Organs in Lung Cancer[1]

Background: Indications for surgical treatment in advanced lung cancer still remain to be established. Methods: The outcomes of combined resection of adjacent organs in lung cancer were assessed in terms of complications and the invasiveness of surgery, using intraoperative blood loss and operation time as indices. Results: In 68 patients undergoing combined resection between 1980 and 1997, the 5-year-survival rates and the incidence of complications and hospital deaths were 24.5 %, 52.9 %,and 10.3%, respectively. The mean blood Ioss and operation time were 1200 ml and 396 minutes. The rares of complications and hospital deaths were significantly higher in the group with 1000 ml or more blood loss, and in the group with 360 minutes or longer operation time. Conclusions: In terms of the survival rate, invasiveness of surgery, and complications, the pleura and pericardium were the best indications for combined surgery. For the thoracic wall, blood loss was greater and the rates of complications and hospital deaths tended to be higher among T3 cases. Both blood loss and operation time tended to be greater in T4 cases. Indications for surgery need to be carefully determined with respect to curability.

Lung cancer - Combined resection - Outcome - Postoperative complication - Invasiveness of surgery

References

• 1 Johnson D H, Einhorn L H, Bartolucci A. et al . Thoracic radiotherapy does not prolong survival in patients with locally advanced, unresectable non-small cell lung cancer.  Ann Intern Med.. 1990;  113 33-8
• 2 Martini N, Yellin A, Ginsberg R J. et al . Management of non-small cell lung cancer with direct mediastinal involvement.  Ann Thorac Surg.. 1994;  58 1447-51
• 3 Tsuchiya R, Asamura H, Kondo H, Goya T, Naruke T. Extended resection of left atrium, great vessels, or both for lung cancer.  Ann Thorac Surg.. 1994;  57 960-5
• 4 Rush V W, Albain K S, Crowley J J. et al . Surgical resection of stage IIIA and lIIB non-small-cell lung cancer after concurrent induction chemoradiotherapy.  J Thorac Cardiovasc Surg.. 1993;  105 97-106
• 5 Nakajima K, Okayasu K, Hiraguchi E, Narita Y, Katoh H, Tanabe T. Bronchopleural fistula after pulmonary resection for lung cancer.  J Jpn Assoc Chest Surg.. 1994;  8 441-6
• 6 Niwa H, Yamakawa Y, Kondo K. et al . Long-term follow-up after extensive surgery for advanced lung cancer.  J Jpn Assoc Chest Surg.. 1994;  8 697-704
• 7 Watanabe Y, Shimizu J, Oda M, Hayashi Y, Watanabe S, Iwa T. Results of surgical treatment in patients with IIIA non-small-cell lung cancer.  Thorac Cardiovasc Surg.. 1991;  39 44-9
• 8 Moriyama S, Shimizu S, Ando A, Date Y, Okabe K, Aoe M. Extended resection for lung cancer and its significance.  Surgical Therapy.. 1995;  72 369-74
• 9 Albertucci M, DeMeester T R, Rothberg M, Hagen J A, Santoscoy R, Smyrk T C. Surgery and the management of peripheral lung tumors adherent to the parietal pleura.  J Thorac Cardiovasc Surg.. 1992;  103 8-13
• 10 Pitz C CM, Brutel dela Rivière A, Elbers H RJ, Westermann C JJ, van den Bosch J MM. Surgical treatment of 125 patients with non-small cell lung cancer and chest wall involvement.  Thorax.. 1996;  51 846-50
• 11 Nakahashi H, Yasumoto K, Ishida T. et al . Results of surgical treatment of patients with T3 non-small cell lung cancer.  Ann Thorac Surg.. 1988;  46 178-81

1 Presented in part at the Fifty-first Annual Meeting of The Japanese Society of Thoracic Surgeons, Tokyo, Japan, Oct 1998