Lung Cancer Invading the Chest Wall: A Plea for En-Bloc Resection but the Need for New Treatment Strategies
|
|
- Ambrose Thompson
- 6 years ago
- Views:
Transcription
1 Lung Cancer Invading the Chest Wall: A Plea for En-Bloc Resection but the Need for New Treatment Strategies Christophe Doddoli, MD, Benoit D Journo, MD, Françoise Le Pimpec-Barthes, MD, Antoine Dujon, MD, Christophe Foucault, MD, Pascal Thomas, MD, and Marc Riquet, MD, PhD Department of Thoracic Surgery, Hôpital Sainte-Marguerite, Marseille, Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Paris, Thoracic Surgery Unit, Centre Médico-Chirurgicale du Cèdre, Boisguillaume, and Unité Propre de Recherche et d Enseignement Supérieur, Equipe d Acceuil 2201, Institut Fédératif de Recherche, Jean Roche, Marseille, France Background. Factors influencing survival of patients with a nonsmall-cell lung cancer (NSCLC) invading the parietal pleura or the chest wall are still controversial. The aim of this study was to assess prognostic factors in completely resected pt3 chest wall NSCLC patients. Methods. We retrospectively reviewed a three-center experience between 1984 and 2002 with 309 patients. Results. There were 269 male and 40 female patients. Pulmonary resections consisted of 13 wedge resections or segmentectomies, 211 lobectomies, 6 bilobectomies, and 79 pneumonectomies. One hundred patients underwent extrapleural mobilization, and 209, en-bloc resection. Tumors were staged as stages IIB (n 212) and IIIA (n 97). Overall 5-year survival rates were 40% and 12% for stage IIB and IIIA, respectively (p < 10 4 ). Multivariate analysis shows male sex and bigger tumor size as independent indicators of poor prognosis in stage IIB patients. In stage IIB patients with a chest wall invasion limited to the parietal pleura, en-bloc resections provided higher 5-year survival rates when compared with extrapleural resections (60.3% versus 39.1%; p 0.03). In stage IIIA patients, multivariate analysis disclosed two independent prognostic factors: the number of resected ribs and adjuvant parietal and mediastinal radiotherapy. Conclusions. The presence of lymph node metastases has a disastrous impact on survival in this subset of patients. En-bloc resection is strongly suggested to be the standard of surgical care, and adjuvant radiotherapy does not seem to be necessary in N0 patients when a complete R0 resection has been achieved. For huge tumors (larger than 6 cm), this report suggests that the role of perioperative chemotherapy needs further evaluation. (Ann Thorac Surg 2005;80: ) 2005 by The Society of Thoracic Surgeons Accepted for publication March 21, Address correspondence to Dr Doddoli, Sainte-Marguerite Hospital, 270, Blvd de Sainte-Marguerite, Marseille Cedex 09, France; christophe.doddoli@mail.ap-hm.fr. The treatment of patients with a nonsmall-cell lung cancer (NSCLC) invading the chest wall remains under debate because of questions about the unresolved issue of the treatment strategy for a locally advanced disease with or without multimodality approaches, and the technical challenge of an extended operation that offers a complete resection. Despite a substantial literature, factors affecting survival are still unclear, excepted the incompleteness of the resection and the presence of lymph node metastases [1 4]. One of the most frequent bias encountered in the available literature is the wide variety of medical and surgical treatment options in most series. To limit as much as possible the influence of such confounding variables, we focused our analysis on a selected sample of 309 patients free of any treatment before surgery, and who received a pathologically proven complete R0 resection. The aim of this study was to identify potential patient-related, tumor-related, and treatment-related factors that may impact on the longterm outcome of patients presenting with a NSCLC invading the chest wall. Patients and Methods Patients From 1984 to 2002, 309 consecutive patients with a pt3 NSCLC invading the chest wall were surgically treated with a complete (R0) resection at three institutions (Sainte-Marguerite Hospital, European Georges Pompidou Hospital, and Boisguillaume Surgical Center). All these patients underwent surgery as the first treatment. Patients with a tumor classified postoperatively as T3 due to the invasion of the diaphragm, the mediastinal pleura, or the pericardium were not included. The subset of patients with a superior sulcus tumor included in the present study had no Pancoast syndrome at presentation, and all received a complete R0 resection through a posterior approach. Not included were those patients with a Pancoast syndrome, or who were deemed to be of doubtful resectability after imaging investigations. All of them received induction chemoradiotherapy, and some 2005 by The Society of Thoracic Surgeons /05/$30.00 Published by Elsevier Inc doi: /j.athoracsur
2 Ann Thorac Surg DODDOLI ET AL 2005;80: LUNG CANCER INVOLVING THE CHEST WALL of them were operated on through an anterior or a combined anterior and posterior approach. Patient charts were identified by screening of a database into which data were entered prospectively for any patient undergoing surgery for lung malignancy at our departments. When chest wall invasion was proven preoperatively (invasion beyond parietal pleura clearly evident on computed tomography (CT) scan or positive bone scintigraphy on ribs), or suspected clinically (chest pain), an en-bloc resection was scheduled. En-bloc resection was also performed in case of intraoperative evidence of deep parietal invasion. Otherwise extrapleural dissection (parietal pleurectomy) was performed when the parietal pleura could be freed easily from the chest wall. One hundred patients (32.4%) underwent an extrapleural resection and the analysis of the specimen confirmed that the depth of chest wall invasion was confined to the parietal pleura in all of them. Two hundred and nine patients (67.6%) had an en-bloc chest wall resection. Lymphadenectomy was done uniformly betweens centers, and this was precisely the reason why the authors chose to pool their experience. An ipsilateral hilar, scissural, and mediastinal lymph node dissection was performed routinely in all patients, and this was checked on the pathology report. Operative reports, pathology reports, hospital reports, and outclinic charts were reviewed. Demographic data of patients and first symptom were collected. Preoperative workup included routine chest radiography, and thoracic and abdominal CT scan. Bone scanning and brain CT scan were performed selectively on the basis of clinical clues. Preoperative workup also included routine biochemical profile, bronchoscopy, pulmonary function tests, and arterial blood gas analysis at rest, as well as quantitative ventilation and perfusion scans in patients in whom predicted postoperative forced expiratory volume in 1 second (FEV 1 ) could be estimated lower than 1 L. Mediastinoscopy was not routinely performed as part of the preoperative workup, except to rule out a N2 disease when suspected on the basis of enlarged mediastinal lymph nodes at CT scan. Types of pulmonary and parietal resections and postoperative complications were collected as well. Postoperative pathological analysis included pathologic type, tumor size, ptnm assessment, chest wall in-depth invasion, presence of vessel invasion, and number of resected ribs. Adjuvant therapy (radiotherapy, chemotherapy, or combination of both) was noted, but only postoperative radiotherapy was submitted to analysis given the wide variety of drug regimens. There was also no uniform attitude to select patients for adjuvant radiotherapy after complete resection. When performed, it consisted of parietal radiotherapy in case of stage IIB disease, and parietal and mediastinal radiotherapy in case of stage IIIA disease. Statistical Analysis Survival was studied in stage IIB (T3N0M0) and IIIA (T3N1M0 and T3N2M0) patients. The following variables were considered as potential prognostic factors of survival: age ( 60 years versus 60 years), sex, side of the resection, number of resected ribs ( 2 versus 2), type of operation (extrapleural versus en-bloc resection), pathologic type (squamous cell carcinoma versus adenocarcinoma versus others), tumor size ( 6 cm versus 6 cm), depth of invasion of the chest wall (pleura versus pleura plus soft tissues versus pleura plus soft tissue plus ribs), blood vessels invasion (yes versus no), and adjuvant radiotherapy (yes versus no). Survival was calculated from the date of surgery until death or the date of last follow-up. Actuarial survival curves were calculated using the Kaplan-Meier method. Comparisons were made using the log-rank test. Univariate and multivariate analysis were performed using Cox proportional hazards regression model to determine factors potentially predicting survival. The Cox model was used to incorporate in the same model any explanatory variables with a p value less than Forward stepwise procedure and likelihood ratio tests were used to select the variables with the greatest prognostic value (p 0.05). This statistical analysis was performed by using the SPSS V10.0 software package (SPSS, Chicago, Illinois). Results 2033 The demographic and surgical data and the pathologic features are shown in Table 1. Thirteen patients had a limited resection because of a poor pulmonary functional status. Complications occurred in 101 patients (32.7%) and resulted in 24 postoperative deaths (7.8%). Respiratory failure was the leading cause of death (n 17). Postoperative mortality rates were 5.7% (12 of 211), 33.3% (2 of 6), and 12.7% (10 of 79) for lobectomy, bilobectomy, and pneumonectomy, respectively. In the 209 patients having undergone an en-bloc resection (n 209), the tumor invaded the parietal pleura only in 38 patients, the pleura and soft tissues in 75, and the pleura, soft tissues and ribs in 96. Large chest wall defects were repaired using a prosthesis in 84 patients (40%): flexible mesh (Vicryl; Ethicon, Somerville, New Jersey) in 68 cases; Marlex (CR Bard, Murray Hill, New Jersey) in 14 cases, and Gore-Tex (Gore and Associates, Flagstaff, Arizona) in 2 cases. Muscle transpositions were associated in 3 cases. The distribution of node involvement according to the depth of chest wall invasion is shown in Table 2. Adjuvant radiotherapy, chemotherapy, or associated radiochemotherapy were administered to, respectively, 131, 10, and 36 patients. At completion of the study, follow-up was complete for 82.8% of patients. The status of the patients at last follow-up is given by Table 3. Median survival was 19 months, and the overall 5-year survival rate was 30.7%. Five-year survival according to the N status was 40%, 23.8%, and 8.4% in cases of N0, N1, and N2 disease, respectively. The difference of survival between N1 and N2 patients was close to statistical significance (p 0.056). Five-year survival rates were 40% and 12% for stage IIB and IIIA, respectively (p 10 4 ; Fig 1). Survival with reference to various variables in stage IIB patients is shown in Table 4. A poorer survival was shown in case of tumor size bigger than 6 cm (Fig 2). GENERAL THORACIC
3 2034 DODDOLI ET AL Ann Thorac Surg LUNG CANCER INVOLVING THE CHEST WALL 2005;80: Table 1. Demographic and Surgical Data and Pathologic Features of the 309 Patients Sex Male 269 (87%) Female 40 (13%) Age (years) Mean Range Location Right 175 (57%) Left 134 (43%) Symptoms Pain 159 (51.46%) Hemoptysis 19 (6.15%) Pain and hemoptysis 11 (3.56%) Others 70 (22.65%) No symptom 50 (16.18%) Parenchymal resection Lobectomy 211 (68.28%) Right upper 110 Right lower 12 Middle 2 Left upper 76 Left lower 11 Bilobectomy 6 (1.95%) Pneumonectomy 79 (25.57%) Wedge/segmentectomy 13 (4.2%) Tumor size (cm) Mean Range Chest wall resection rib 27 (12.92%) 2 ribs 66 (31.57%) 3 ribs 80 (38.28%) 4 ribs 33 (15.8%) 5 ribs 3 (1.43%) Histology Squamous cell carcinoma 130 (42.07%) Adenocarcinoma 100 (35.6%) Others 69 (22.33%) Five-year survival was also negatively influenced by male sex and chest wall resection including more than 2 ribs. Survival was not significantly modified by the type of pulmonary and chest wall resection, the depth of chest wall invasion, histology, and performance of adjuvant parietal radiotherapy. At multivariate analysis, two independent prognostic factors entered the model: sex and tumor size (Table 5). For these tumors IIB, an en-bloc resection was found to increase survival significantly in patients with invasion limited to the parietal pleura (39.1% for extrapleural mobilization versus 60.3% for en-bloc resection, p 0.03; Fig 3). The status at last follow-up of these patients is shown in Table 6. The survival of stage IIIA patients with reference to various variables is shown in Table 7. At multivariate analysis, two independent prognostic factors entered the model: number of resected ribs, and adjuvant parietal and mediastinal radiotherapy (Table 8). In these stage IIIA patients, overall 5-year survival was not influenced by the type of the parietal resection when the tumoral invasion was limited to the parietal pleura (13.9% for extrapleural mobilization versus 0 % for en-bloc resection, p 0.19). Comment The present results show several particular features of chest wall pt3 (stage IIB and IIIA), with the limitations due to the retrospective and multicenter nature of this study, the design of which was dictated by the relatively rare frequency of such disease in the setting of a surgical treatment: fewer than 5% of all pulmonary resections for lung cancer performed during the same period at our institutions and 5.6% in others [5]. Our choice to include patients with a superior sulcus tumor may be questionable given their usual worse prognostic profile and different treatment strategies, including induction chemoradiotherapy. We emphasize on the facts that only those patients without a Pancoast syndrome at presentation, and having received a complete R0 resection after a first-line surgery through a posterior approach were considered. These criteria undoubtedly define a highly selected subset of patients for whom there is no clear rationale to anticipate a different outcome than that of patients operated on from a tumor invading other areas of the chest wall. Of note, these patients are not usually excluded from those studies dealing with combined modalities treatment, although one may oppose that their outcome would probably bias the overall results favorably. Demographic and clinical features in our study were not different of what is typically reported in the literature [4 8]. Pulmonary resections consisting of a majority of lobectomy are also usual [3 11]. We performed a relatively high percentage of pneumonectomy (25%), did Table 2. Distribution of Node Involvement in the Chest Wall pt3 N0 (%) N1 (%) N2 (%) Total Pleura 91 (65.94) 16 (11.59) 31 (22.46) 138 Pleura soft tissues 53 (70.67) 8 (10.67) 14 (18.67) 75 Pleura soft tissue ribs 68 (70.83) 8 (8.33) 20 (20.83) 96 Total
4 Ann Thorac Surg DODDOLI ET AL 2005;80: LUNG CANCER INVOLVING THE CHEST WALL Table 3. Patient s Status at Last Follow-Up Status Extrapleural Resection n 100 En-Bolc Resection n 209 All Patients n 309 p Value Dies postoperatively test No recurrence test Alive Dead With recurrence test Alive Dead GENERAL THORACIC Downey and associates [4] and Magdeleinat and coworkers [6], who reported similar percentages of 20% and 27%, respectively. After large parietal resections, 40% of our patients required a dedicated reconstruction, mainly to avoid the incarceration of the scapula inside the chest wall defect after posterior resections, and to limit paradoxical chest wall motion for anterolateral defects. The percentage of such reconstruction varies from 0% to 64% in the literature [5 8, 11]. Postoperative mortality was in the range of what is reported by the literature [4, 6, 8, 11], but the rate observed after pneumonectomy was high (12.7%). Unfortunately, very few data are available regarding this topic, which makes comparison difficult [1, 8, 11]. Most papers reported on overall mortality, without emphasis or special attention to that of patients having received pneumonectomy [2, 4, 6, 9, 12, 13]. Most of the pathologic characteristics in this study do not differ from those reported in other major series. Mean tumor size ranged from 5.1 and 7.1 cm in the literature [1, 4, 9, 11, 14], and was 6.1 cm in the present series. Although a complete lymph node dissection was not performed routinely by all surgeons having published on this topic, the prevalence of N0 disease seems to be a relatively common feature, observed in about 60% of the reported cases [1, 3 7, 9, 11, 14], and in 68.6% in our experience. Survival and prognostic factors focused our attention because of the nonhomogeneous information brought by the literature. Five-year survival rate was 40% for our Fig 1. Overall survival according to the stage. stage IIB patients, whereas the usually reported rates range from 22% to 78.5% [1 9, 11]. This relatively large scale reflects patients samples of uneven sizes [1 3, 9], variable treatment modalities [1, 4 6, 9, 11], and different surgical policies [1 11]. Conversely, all authors join to underline the disastrous impact of the presence of lymph nodes metastases, with an attached 5-year survival around 10% (12% in our experience) [1, 8, 9, 12, 15], with some series culminating at 20% [2, 5, 6, 11] as the result of a stage migration effect (Will Rogers phenomenon) according to the proportion of patients with a clinically occult N disease [6, 11]. The results of our multivariate analysis clearly showed that the lymph node status canceled the impact of any other potential prognosticator. Obviously, this evidence should lead to improve selection methods to allocate those patients to multimodality strategies including induction therapies. Of note, our multivariate analysis identified the performance of adjuvant radiotherapy as an independent determinant of survival in stage IIIA patients, whereas it was not the case in stage IIB patients. This difference may be because, in most cases, radiotherapy consisted of parietal and mediastinal radiation in stage IIIA patients, but parietal radiation only in stage IIB patients. The second explanation relies on the adjunction of chemotherapy preferentially in stage IIIA patients. Anyway, one should point out that the chances for cure for T3 stage IIIA patients are so low that it remains unclear whether surgery is of any benefit for these patients, especially when a pneumonectomy is required. Tumor size is a classical factor in the study on survival in NSCLC. A 3-cm cutoff point separates T1 from T2 tumors, whereas a size larger than 3 cm is not ascribed any prognostic value. The cancer-related death risk does not seem to increase in line with tumor size for each of the pathologic stages, in a significant and independent fashion. For instance, stratifying patients with stage IA NSCLC according to their tumor size gave no apparent difference in survival [16, 17]. Conversely, tumors with a diameter of 5 cm or larger determine the same survival as some categories of T3N0M0 [18, 19]. Comparatively, stratifying our patients with pt3 chest wall NSCLC according to tumor size gave an apparent difference in survival for patients with a stage IIB tumor. We report a quite good 5-year survival rate (45.9%) for patients with a tumor size of less than 6 cm. Tumor size, by itself, thus
5 2036 DODDOLI ET AL Ann Thorac Surg LUNG CANCER INVOLVING THE CHEST WALL 2005;80: Table 4. Relationship Between Variables and 5-Year Survival for Patients Having Pathology Stage IIB Variable No. of Observations (n 212) 5 Years 95% Confidence Interval Lower Upper p Value Age 60 years years Sex Male Female Side of resection Right Left Resected ribs Histology Squamous cell carcinoma Adenocarcinoma Others Tumor size 6 cm cm In-depth chest wall invasion Pleura Pleura soft tissues Pleura soft tissue ribs Vessel invasion No Yes Adjuvant radiotherapy No Yes appears as a putatively strong prognostic factor of longterm outcome in pt3n0 chest wall patients. To our knowledge, this finding was not yet recognized for this pathologic stage. The explanation may be pragmatic only, as it may be more difficult to obtain wide and clear Fig 2. Overall survival according to the tumor size in stage IIB patients. surgical margins with huge tumors. As the primary goal of surgery remains a complete resection with free margins, as stressed by the absence of 2.5-year survivors among incompletely resected patients [2], this finding may be the rationale for investigating the value of induction therapy for huge tumors. Similar to the findings of Chapelier and associates [8], we found that the extent of the chest wall resection assessed by the number of removed ribs was a predictor of survival only at univariate analysis in stage IIB patients. In contrast, this variable entered the multivariate analysis of stage IIIA patients. Depth invasion of the chest wall was not correlated with survival, despite a poor prognosis in patients with N0 disease and invasion of all components of the chest wall. This finding was in agreement with some experiences [7, 11, 20], but in contrast with others in which survival was better when tumoral invasion was confined to the parietal pleura [4 6, 8, 21]. Among the patients with invasion limited to the parietal pleura, the type of resection (extrapleural mobilization or en-bloc resection) affected survival in cases of N0 disease. This result is consistent with previ-
6 Ann Thorac Surg DODDOLI ET AL 2005;80: LUNG CANCER INVOLVING THE CHEST WALL Table 5. Univariate and Multivariate Analyses of Prognostic Factors in Pathology Stage IIB Chest Wall Patients Variable p Value Univariate Analysis Hazard Ratio Multivariate Analysis % Confidence Interval 95% Confidence Interval Lower Upper p Value Hazard Ratio Lower Upper GENERAL THORACIC Age ( 60 vs years) Sex (female vs male) Side of resection (right vs left) Resected ribs ( vs 2) Histology Others vs ADK Others vs SCC Tumor size ( 6vs cm) In-depth chest wall invasion PvsP St PvsP ST R Vessels invasion (yes vs/no) Adjuvant radiotherapy (yes vs no) Type of resection (extrapleural vs en bloc) ADK adenocarcinoma; P pleura; P ST pleura soft tissues; P St R pleura soft tissue ribs; SCC squamous cell carcinoma. Fig 3. Overall survival according to the type of resection for tumors involving only parietal pleura in stage IIB patients. ously reported findings [3, 9]. The explanation of the benefit of this apparent overtreatment is probably artefactual. Indeed, performing a full-thickness en-bloc resection logically decreases the risk of leaving a residual disease. As a matter of fact, the analysis of the subgroup of N0 patients with a chest wall invasion limited to the parietal pleura suggested that patients undergoing extrapleural mobilization developed more local relapses (18%) than those treated by full-thickness en-bloc resection (4%), and in turn had a significantly worse survival rate as well. The absence of survival difference according to the type of chest wall resection noticed in N patients is probably due to the higher prognostic weight provided by a lymph node invasion, canceling that of a microscopically incomplete resection. So the concept of performing routinely an en-bloc resection even if the parietal pleura could easily be cleaved from the chest wall is strongly sustained by our results and is clinically relevant, even if this issue remains controversial [2, 4, 6, 13]. In our study, female sex was a significant predictor of long-term survival in stage IIB patients. Burkhart and associates [11] have recently reported a similar finding. However, this effect is usually pronounced at early disease stages [22 24]. Lung cancer in women when compared with men has generally the following characteristics: younger age of onset, less smoking, and more adenocarcinoma. Of note, these characteristics were not observed in our experience. Some reports suggest that NSCLC may be under hormonal control [25]. In addition, the presence of an allele loss that occurs more frequently in men and is associated with decreased survival has recently been reported [26].
7 2038 DODDOLI ET AL Ann Thorac Surg LUNG CANCER INVOLVING THE CHEST WALL 2005;80: Table 6. Status of IIB Patients With Involvement of Only Parietal Pleura Status at Last Follow-up Extrapleural Resection n 66 En-Bloc Resection n 25 p Value Died postoperatively (Fisher s test) No recurrence ( 2 test) Alive Dead 7 3 With local general recurrence (Fisher s test) Alive 2 0 Dead 10 1 With general recurrence only ( 2 test) Alive 4 1 Dead 21 6 Whether adjuvant radiotherapy is needed in chest wall pt3 NSCLC is still an open issue. We did not observe any difference in terms of local relapse and overall survival in stage IIB patients with regard to the administration of postoperative radiotherapy. In contrast, adjuvant radiotherapy increased survival in stage IIIA patients. It may be hypothesized that N0 patients having undergone a R0 resection did not need any adjuvant radiotherapy to achieve a suitable local control of the disease. Conversely, besides the bias due to the frequent adjunction of chemotherapy in stage IIIA patients, it may be speculated that mediastinal radiotherapy improved the local Table 7. Relationship Between Variables and 5-Year Survival for Patients Having Pathology State IIIA Variable No. of Observations (n 97) 5 Years 95% Confidence Interval Lower Upper p Value Age 60 years years Sex male Female Side of resection Right left Resected ribs Pathology Squamous cell carcinoma Adenocarcinoma Others Tumor size 6 cm cm In-depth chest wall invasion Pleura Pleura soft tissues Pleura soft tissue ribs Vessel invasion No Yes 19 0 Adjuvant radiotherapy No Yes
8 Ann Thorac Surg DODDOLI ET AL 2005;80: LUNG CANCER INVOLVING THE CHEST WALL Table 8. Univariate and Multivariate Analyses of Prognostic Factors in Pathology Stage IIIA Chest Wall Patients Variable p Value Univariate Analysis Hazard Ratio Multivariate Analysis % Confidence Interval 95% Confidence Interval Lower Upper p Value Hazard Ratio Lower Upper GENERAL THORACIC Age ( 60 vs 60 years) Gender (female vs male Side of resection (right vs left) Resected ribs ( 2vs 2) Pathology ADK vs SCC ADK vs others Tumor size ( 6vs cm) In-depth chest wall invasion P ST vs P P ST vs. P ST R Vessels invasion (yes vs no) Adjuvant radiotherapy (yes vs no) Type of resection (extrapleural vs en bloc) ADK adenocarcinoma; P pleura; P ST pleura soft tissues; P ST R pleura soft tissue ribs; SCC squamous cell carcinoma. control of the disease in N patients. However, our study, as well as most publications, sins by the absence of a uniform protocol employed in those patients [1, 4 6, 9, 13]. To conclude, the present results highlight several particular features of chest wall pt3 NSCLC patients. The disastrous impact of lymph node metastases on survival leads to questions of whether surgery is of any benefit in this subset of patients. The best surgical candidates are likely to be those with a N0 disease. In that way, en-bloc resection is strongly suggested to be the standard of surgical care, and adjuvant radiotherapy does not seem to be necessary if a complete resection has been achieved. For huge tumors, this report suggests that the role of perioperative chemotherapy needs further evaluation. References 1. Piehler JM, Pairolero PC, Weiland LH, Offord KP, Payne WS, Bernatz PE. Bronchogenic carcinoma with chest wall invasion: factors affecting survival following en bloc resection. Ann Thorac Surg 1982;34: McCaughan BC, Martini N, Bains MS, McCormack PM. Chest wall invasion in carcinoma of the lung. Therapeutic and prognostic implications. J Thorac Cardiovasc Surg 1985; 89: Albertucci M, DeMeester TR, Rothberg M, Hagen JA, Santoscoy R, Smyrk TC. Surgery and the management of peripheral lung tumors adherent to the parietal pleura. J Thorac Cardiovasc Surg 1992;103: Downey RJ, Martini N, Rusch VW, Bains MS, Korst RJ, Ginsberg RJ. Extent of chest wall invasion and survival in patients with lung cancer. Ann Thorac Surg 1999;68: Facciolo F, Cardillo G, Lopergolo M, Pallone G, Sera F, Martelli M. Chest wall invasion in non-small cell lung carcinoma: a rationale for en bloc resection. J Thorac Cardiovasc Surg 2001;121: Magdeleinat P, Alifano M, Benbrahem C, et al. Surgical treatment of lung cancer invading the chest wall: results and prognostic factors. Ann Thorac Surg 2001;71: Elia S, Griffo S, Gentile M, Costabile R, Ferrante G. Surgical treatment of lung cancer invading chest wall: a retrospective analysis of 110 patients. Eur J Cardiothorac Surg 2001;20: Chapelier A, Fadel E, Macchiarini P, et al. Factors affecting long-term survival after en-bloc resection of lung cancer invading the chest wall. Eur J Cardiothorac Surg 2000;18: Allen MS, Mathisen DJ, Grillo HC, Wain JC, Moncure AC, Hilgenberg AD. Bronchogenic carcinoma with chest wall invasion. Ann Thorac Surg 1991;51: Roviaro G, Varoli F, Grignani F, et al. Non-small cell lung cancer with chest wall invasion: evolution of surgical treatment and prognosis in the last 3 decades. Chest 2003;123: Burkhart HM, Allen MS, Nichols FC III, et al. Results of en bloc resection for bronchogenic carcinoma with chest wall invasion. J Thorac Cardiovasc Surg 2002;123: Casillas M, Paris F, Tarrazona V, Padilla J, Paniagua M, Galan G. Surgical treatment of lung carcinoma involving the chest wall. Eur J Cardiothorac Surg 1989;3: Pitz CC, Brutel de la Riviere A, Elbers HR, Westermann CJ, van den Bosch JM. Surgical treatment of 125 patients with non-small cell lung cancer and chest wall involvement. Thorax 1996;51:
9 2040 DODDOLI ET AL Ann Thorac Surg LUNG CANCER INVOLVING THE CHEST WALL 2005;80: Ribet M, al Nashawati G. Bronchial cancers invading the chest wall. Rev Mal Respir 1992;9: Carrel T, Nachbur B, Veraguth P. En bloc resection for bronchogenic carcinoma with chest wall invasion. Value of pre-operative radiotherapy. Eur J Cardiothorac Surg 1990;4: Yanagi S, Sugiura H, Morikawa T, et al. Tumor size does not have prognostic significance in stage Ia NSCLC. Anticancer Res 2000;20: Patz EF Jr, Rossi S, Harpole DH Jr, Herndon JE, Goodman PC. Correlation of tumor size and survival in patients with stage IA non-small cell lung cancer. Chest 2000;117: Padilla J, Calvo V, Penalver JC, et al. Survival and risk model for stage IB non-small cell lung cancer. Lung Cancer 2002; 36: Carbone E, Asamura H, Takei H, et al. T2 tumors larger than five centimeters in diameter can be upgraded to T3 in non-small cell lung cancer. J Thorac Cardiovasc Surg 2001; 122: Riquet M, Lang-Lazdunski L, Le Pimpec-Barthes F, et al. Characteristics and prognosis of resected T3 non-small cell lung cancer. Ann Thorac Surg 2002;73: Ramsey HE, Cliffton EE. Chest wall resection for primary carcinoma of the lung. Ann Surg 1968;167: De Perrot M, Licker M, Bouchardy C, Usel M, Robert J, Spiliopoulos A. Sex differences in presentation, management, and prognosis of patients with non-small cell lung carcinoma. J Thorac Cardiovasc Surg 2000;119: Ferguson MK, Wang J, Hoffman PC, et al. Sex-associated differences in survival of patients undergoing resection for lung cancer. Ann Thorac Surg 2000;69: Alexiou C, Onyeaka CV, Beggs D, et al. Do women live longer following lung resection for carcinoma? Eur J Cardiothorac Surg 2002;21: Canver CC, Memoli VA, Vanderveer PL, Dingivan CA, Mentzer RM Jr. Sex hormone receptors in non-small cell lung cancer in human beings. J Thorac Cardiovasc Surg 1994;108: Schreiber G, Fong KM, Peterson B, Johnson BE, O Briant KC, Bepler G. Smoking, gender, and survival association with allele loss for the LOH11B lung cancer region on chromosome 11. Cancer Epidemiol Biomark Prev 1997;6: INVITED COMMENTARY Doddoli and colleagues [1] have reported the largest series of patients with completely resected nonsmall cell lung cancer invading the chest wall. Their series is a retrospective analysis and it confirms the results of other large series in most respects. Because all of the patients in this series underwent complete (R0) resection, the main influence on overall survival was the presence or absence of lymph node metastases. T3N0M0 (stage IIB) patients had a median and 5-year survival of 19 months and 40%, respectively. Patients staged IIIA (T3N1M0 or T3N2M0) had a 12% 5-year survival (p 10 4 ). T3N0 patients did not benefit from adjuvant radiotherapy to the chest wall. Novel findings included the fact that based on their multivariate analysis stage IIIA patients seemed to benefit in terms of survival from adjuvant radiotherapy to the chest wall and mediastinum. The authors also noted that in the stage IIB subgroup of patients with tumor invasion limited to the parietal pleura, the survival rate of those patients undergoing en bloc chest wall resection was greater than that of patients undergoing extrapleural resection. This is a controversial finding not consistently supported in the literature. Certainly if there is any question of tumor invasion beyond the parietal pleura, en bloc resection of the chest wall should be performed. An unusual aspect of this series is the inclusion of patients with superior sulcus tumors. Superior sulcus tumors are usually not included in series of lung cancers invading the chest wall because they may have higher local recurrence rates, require a unique operative approach, and so forth. The authors justify the inclusion of these patients by saying that none of those included had Pancoast syndrome. Surely some of these patients had pain because all had T3 tumors, although they may not have had Horner s syndrome and muscle wasting. The best approach would have been for the authors to analyze these patients separately within the report or to at least tell us how many patients with superior sulcus tumors were included in their series. Walter J. Scott, MD Thoracic Surgical Oncology Fox Chase Cancer Center Suite C Cottman Avenue Philadelphia, PA w_scott@fccc.edu Reference 1. Doddoli C, D Journo B, Le Pimpec-Barthes F, et al. Lung cancer invading the chest wall: a plea for en-bloc resection but the need for new treatment strategies. Ann Thorac Surg 2005;80: by The Society of Thoracic Surgeons /05/$30.00 Published by Elsevier Inc doi: /j.athoracsur
Lung cancer involving neighboring structures is classified
GENERAL THORACIC Subcategorization of Resectable Non-Small Cell Lung Cancer Involving Neighboring Structures Noriaki Sakakura, MD, Shoichi Mori, MD, Futoshi Ishiguro, MD, Takayuki Fukui, MD, Shunzo Hatooka,
More informationPrognostic value of visceral pleura invasion in non-small cell lung cancer q
European Journal of Cardio-thoracic Surgery 23 (2003) 865 869 www.elsevier.com/locate/ejcts Prognostic value of visceral pleura invasion in non-small cell lung cancer q Jeong-Han Kang, Kil Dong Kim, Kyung
More informationLung cancer with chest wall involvement: Predictive factors of long-term survival after surgical resection
Lung Cancer (2006) 52, 359 364 available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/lungcan Lung cancer with chest wall involvement: Predictive factors of long-term survival after
More informationCHEST WALL INVASION IN NON SMALL CELL LUNG CARCINOMA: A RATIONALE FOR EN BLOC RESECTION
CHEST WALL INVASION IN NON SMALL CELL LUNG CARCINOMA: A RATIONALE FOR EN BLOC RESECTION Francesco Facciolo, MD a Giuseppe Cardillo, MD a Michele Lopergolo, MD a Guido Pallone, MD a Francesco Sera, DSc
More informationThe Value of Adjuvant Radiotherapy in Pulmonary and Chest Wall Resection for Bronchogenic Carcinoma
The Value of Adjuvant Radiotherapy in Pulmonary and Chest Wall Resection for Bronchogenic Carcinoma G. A. Patterson, M.D., R. Ilves, M.D., R. J. Ginsberg, M.D., J. D. Cooper, M.D., T. R. J. Todd, M.D.,
More informationVisceral pleural involvement (VPI) of lung cancer has
Visceral Pleural Involvement in Nonsmall Cell Lung Cancer: Prognostic Significance Toshihiro Osaki, MD, PhD, Akira Nagashima, MD, PhD, Takashi Yoshimatsu, MD, PhD, Sosuke Yamada, MD, and Kosei Yasumoto,
More informationAlthough the international TNM classification system
Prognostic Significance of Perioperative Serum Carcinoembryonic Antigen in Non-Small Cell Lung Cancer: Analysis of 1,000 Consecutive Resections for Clinical Stage I Disease Morihito Okada, MD, PhD, Wataru
More informationMarcel Th. M. van Rens, MD; Aart Brutel de la Rivière, MD, PhD, FCCP; Hans R. J. Elbers, MD, PhD; and Jules M. M. van den Bosch, MD, PhD, FCCP
Prognostic Assessment of 2,361 Patients Who Underwent Pulmonary Resection for Non-small Cell Lung Cancer, Stage I, II, and IIIA* Marcel Th. M. van Rens, MD; Aart Brutel de la Rivière, MD, PhD, FCCP; Hans
More informationLA RADIOTERAPIA NEL TRATTAMENTO INTEGRATO DEL CANCRO DEL POLMONE NON MICROCITOMA NSCLC I-II
AUSL BA/4 Ospedale S. Paolo Bari U.O. Complessa di Chirurgia Toracica LA RADIOTERAPIA NEL TRATTAMENTO INTEGRATO DEL CANCRO DEL POLMONE NON MICROCITOMA NSCLC I-II stadio L opinione del chirurgo Francesco
More informationFactors affecting survival in non-small cell lung cancer invading the chest wall.
Biomedical Research 2017; 28 (6): 2673-2678 ISSN 0970-938X www.biomedres.info Factors affecting survival in non-small cell lung cancer invading the chest wall. Abidin Sehitogullari 1, Yusuf Aydemir 2*,
More informationAccording to the current International Union
Treatment of Stage II Non-small Cell Lung Cancer* Walter J. Scott, MD, FCCP; John Howington, MD, FCCP; and Benjamin Movsas, MD Based on clinical assessment alone, patients with stage II non-small cell
More informationThe right middle lobe is the smallest lobe in the lung, and
ORIGINAL ARTICLE The Impact of Superior Mediastinal Lymph Node Metastases on Prognosis in Non-small Cell Lung Cancer Located in the Right Middle Lobe Yukinori Sakao, MD, PhD,* Sakae Okumura, MD,* Mun Mingyon,
More informationLung cancer is a major cause of cancer deaths worldwide.
ORIGINAL ARTICLE Prognostic Factors in 3315 Completely Resected Cases of Clinical Stage I Non-small Cell Lung Cancer in Japan Teruaki Koike, MD,* Ryosuke Tsuchiya, MD, Tomoyuki Goya, MD, Yasunori Sohara,
More informationSuperior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis
ORIGINAL ARTICLES: Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis Shun-ichi Watanabe, MD, Kenji Suzuki, MD, and Hisao Asamura, MD
More informationHISTORY SURGERY FOR TUMORS WITH INVASION OF THE APEX 15/11/2018
30 EACTS Annual Meeting Barcelona, Spain 1-5 October 2016 SURGERY FOR TUMORS WITH INVASION OF THE APEX lung cancer of the apex of the chest involving any structure of the apical chest wall irrespective
More informationPulmonary resection remains the most effective. Survival in Synchronous vs Single Lung Cancer. Upstaging Better Reflects Prognosis
Survival in Synchronous vs Single Lung Cancer Upstaging Better Reflects Prognosis Marcel Th. M. van Rens, MD; Pieter Zanen, MD, PhD; Aart Brutel de la Rivière, MD, PhD, FCCP; Hans R. J. Elbers, MD, PhD;
More informationLYMPH NODE METASTASIS IN SMALL PERIPHERAL ADENOCARCINOMA OF THE LUNG
LYMPH NODE METASTASIS IN SMALL PERIPHERAL ADENOCARCINOMA OF THE LUNG Tsuneyo Takizawa, MD a Masanori Terashima, MD a Teruaki Koike, MD a Takehiro Watanabe, MD a Yuzo Kurita, MD b Akira Yokoyama, MD b Keiichi
More informationT3 NSCLC: Chest Wall, Diaphragm, Mediastinum
for T3 NSCLC: Chest Wall, Diaphragm, Mediastinum AATS Postgraduate Course April 29, 2012 Thomas A. D Amico MD Professor of Surgery, Chief of Thoracic Surgery Duke University Health System Disclosure No
More informationLung cancer pleural invasion was recognized as a poor prognostic
Visceral pleural invasion classification in non small cell lung cancer: A proposal on the basis of outcome assessment Kimihiro Shimizu, MD a Junji Yoshida, MD a Kanji Nagai, MD a Mitsuyo Nishimura, MD
More informationVisceral Pleura Invasion by Non-Small Cell Lung Cancer: An Underrated Bad Prognostic Factor
Visceral Pleura Invasion by Non-Small Cell Lung Cancer: An Underrated Bad Prognostic Factor Dominique Manac h, MD, Marc Riquet, MD, PhD, Jacques Medioni, MD, Françoise Le Pimpec-Barthes, MD, Antoine Dujon,
More informationLung cancer is a prevalent health problem worldwide. It is the leading cause
Prognostic factors in resected stage I non small cell lung cancer with a diameter of 3 cm or less: Visceral pleural invasion did not influence overall and disease-free survival Jung-Jyh Hung, MD, a,b Chien-Ying
More informationTristate Lung Meeting 2014 Pro-Con Debate: Surgery has no role in the management of certain subsets of N2 disease
Tristate Lung Meeting 2014 Pro-Con Debate: Surgery has no role in the management of certain subsets of N2 disease Jennifer E. Tseng, MD UFHealth Cancer Center-Orlando Health Sep 12, 2014 Background Approximately
More informationSlide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology
Slide 1 Investigation and management of lung cancer Robert Rintoul Department of Thoracic Oncology Papworth Hospital Slide 2 Epidemiology Second most common cancer in the UK (after breast). 38 000 new
More informationRevisit of Primary Malignant Neoplasms of the Trachea: Clinical Characteristics and Survival Analysis
Jpn J Clin Oncol 1997;27(5)305 309 Revisit of Primary Malignant Neoplasms of the Trachea: Clinical Characteristics and Survival Analysis -, -, - - 1 Chest Department and 2 Section of Thoracic Surgery,
More informationThe lung cancer cure rate is dismal and has. The Effect of Tumor Size on Curability of Stage I Non-small Cell Lung Cancers*
The Effect of Tumor Size on Curability of Stage I Non-small Cell Lung Cancers* Juan P. Wisnivesky, MD, MPH; David Yankelevitz, MD; and Claudia I. Henschke, PhD, MD, FCCP Objective: The objective of this
More informationTHORACIC MALIGNANCIES
THORACIC MALIGNANCIES Summary for Malignant Malignancies. Lung Ca 1 Lung Cancer Non-Small Cell Lung Cancer Diagnostic Evaluation for Non-Small Lung Cancer 1. History and Physical examination. 2. CBCDE,
More informationPost-Induction PET Does Not Correlate with Persistent Nodal Disease or Overall Survival in Surgically Treated Stage IIIA Non-Small Cell Lung Cancer
Post-Induction PET Does Not Correlate with Persistent Nodal Disease or Overall Survival in Surgically Treated Stage IIIA Non-Small Cell Lung Cancer R. Taylor Ripley, Kei Suzuki, Kay See Tan, Manjit Bains,
More informationPrognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China
www.springerlink.com Chin J Cancer Res 23(4):265 270, 2011 265 Original Article Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai,
More informationImpact of Large Tumor Size on Survival After Resection of Pathologically Node Negative (pn0) Non Small Cell Lung Cancer
Impact of Large Tumor Size on Survival After Resection of Pathologically Node Negative (pn0) Non Small Cell Lung Cancer Shin-ichi Takeda, MD, Shimao Fukai, MD, Hikotaro Komatsu, MD, Etsuo Nemoto, MD, Kenji
More informationStage IB Nonsmall Cell Lung Cancers: Are They All the Same?
ORIGINAL ARTICLES: GENERAL THORACIC GENERAL THORACIC SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article,
More informationComplex Thoracoscopic Resections for Locally Advanced Lung Cancer
Complex Thoracoscopic Resections for Locally Advanced Lung Cancer Duke Thoracoscopic Lobectomy Workshop March 21, 2018 Thomas A. D Amico MD Gary Hock Professor of Surgery Section Chief, Thoracic Surgery,
More informationORIGINAL PAPER. Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery
Nagoya J. Med. Sci. 79. 37 ~ 42, 2017 doi:10.18999/nagjms.79.1.37 ORIGINAL PAPER Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery Naoki Ozeki, Koji
More informationExtent of visceral pleural invasion and the prognosis of surgically resected node-negative non-small cell lung cancer
Thoracic Cancer ISSN 1759-7706 ORIGINAL ARTICLE Extent of visceral pleural invasion and the prognosis of surgically resected node-negative non-small cell lung cancer Yangki Seok 1, Ji Yun Jeong 2 & Eungbae
More informationIn 1989, Deslauriers et al. 1 described intrapulmonary metastasis
ORIGINAL ARTICLE Prognosis of Resected Non-Small Cell Lung Cancer Patients with Intrapulmonary Metastases Kanji Nagai, MD,* Yasunori Sohara, MD, Ryosuke Tsuchiya, MD, Tomoyuki Goya, MD, and Etsuo Miyaoka,
More informationAfter primary tumor treatment, 30% of patients with malignant
ESTS METASTASECTOMY SUPPLEMENT Alberto Oliaro, MD, Pier L. Filosso, MD, Maria C. Bruna, MD, Claudio Mossetti, MD, and Enrico Ruffini, MD Abstract: After primary tumor treatment, 30% of patients with malignant
More informationComplete surgical excision remains the greatest potential
ORIGINAL ARTICLE Wedge Resection for Non-small Cell Lung Cancer in Patients with Pulmonary Insufficiency: Prospective Ten-Year Survival John P. Griffin, MD,* Charles E. Eastridge, MD, Elizabeth A. Tolley,
More informationThe tumor, node, metastasis (TNM) staging system of lung
ORIGINAL ARTICLE Peripheral Direct Adjacent Lobe Invasion Non-small Cell Lung Cancer Has a Similar Survival to That of Parietal Pleural Invasion T3 Disease Hao-Xian Yang, MD, PhD,* Xue Hou, MD, Peng Lin,
More informationThe accurate assessment of lymph node involvement is
ORIGINAL ARTICLE Which is the Better Prognostic Factor for Resected Non-small Cell Lung Cancer The Number of Metastatic Lymph Nodes or the Currently Used Nodal Stage Classification? Shenhai Wei, MD, PhD,*
More informationThe roles of adjuvant chemotherapy and thoracic irradiation
Factors Predicting Patterns of Recurrence After Resection of N1 Non-Small Cell Lung Carcinoma Timothy E. Sawyer, MD, James A. Bonner, MD, Perry M. Gould, MD, Robert L. Foote, MD, Claude Deschamps, MD,
More informationThe T4 category of lung cancer is defined by invasion of the
Original Article Results of T4 Surgical Cases in the Japanese Lung Cancer Registry Study Should Mediastinal Fat Tissue Invasion Really be Included in the T4 Category? Shun-ichi Watanabe, MD,* Hisao Asamura,
More informationProper Treatment Selection May Improve Survival in Patients With Clinical Early-Stage Nonsmall Cell Lung Cancer
Proper Treatment Selection May Improve Survival in Patients With Clinical Early-Stage Nonsmall Cell Lung Cancer Özcan Birim, MD, A. Pieter Kappetein, MD, PhD, Tom Goorden, MD, Rob J. van Klaveren, MD,
More informationInduction chemotherapy followed by surgical resection
Surgical Resection for Residual N 2 Disease After Induction Chemotherapy Jeffrey L. Port, MD, Robert J. Korst, MD, Paul C. Lee, MD, Matthew A. Levin, BS, David E. Becker, MA, Roger Keresztes, MD, and Nasser
More informationLONG-TERM SURGICAL OUTCOMES OF 1018 PATIENTS WITH EARLY STAGE NSCLC IN ACOSOG Z0030 (ALLIANCE) TRIAL
LONG-TERM SURGICAL OUTCOMES OF 1018 PATIENTS WITH EARLY STAGE NSCLC IN ACOSOG Z0030 (ALLIANCE) TRIAL Stacey Su, MD; Walter J. Scott, MD; Mark S. Allen, MD; Gail E. Darling, MD; Paul A. Decker, MS; Robert
More informationPostoperative Mortality in Lung Cancer Patients
Review Postoperative Mortality in Lung Cancer Patients Kanji Nagai, MD, Junji Yoshida, MD, and Mitsuyo Nishimura, MD Surgery for lung cancer frequently results in serious life-threatening complications,
More informationLymph node dissection for lung cancer is both an old
LOBE-SPECIFIC EXTENT OF SYSTEMATIC LYMPH NODE DISSECTION FOR NON SMALL CELL LUNG CARCINOMAS ACCORDING TO A RETROSPECTIVE STUDY OF METASTASIS AND PROGNOSIS Hisao Asamura, MD Haruhiko Nakayama, MD Haruhiko
More informationRole of Surgery in Management of Non Small Cell Lung Cancer. Dr. Ahmed Bamousa Consultant thoracic surgery Prince Sultan Military Medical City
Role of Surgery in Management of Non Small Cell Lung Cancer Dr. Ahmed Bamousa Consultant thoracic surgery Prince Sultan Military Medical City Introduction Surgical approach Principle and type of surgery
More informationPredicting Postoperative Pulmonary Function in Patients Undergoing Lung Resection*
Predicting Postoperative Pulmonary Function in Patients Undergoing Lung Resection* Bernhardt G. Zeiher, MD; Thomas ]. Gross, MD; Jeffery A. Kern, MD, FCCP; Louis A. Lanza, MD, FCCP; and Michael W. Peterson,
More informationNode-Negative Non-small Cell Lung Cancer
ORIGINAL ARTICLE Node-Negative Non-small Cell Lung Cancer Pathological Staging and Survival in 1765 Consecutive Cases Benjamin M. Robinson, BSc, MBBS, Catherine Kennedy, RMRA, Jocelyn McLean, RN, MN, and
More informationThe Prognostic Value of Ratio-Based Lymph Node Staging in Resected Non Small-Cell Lung Cancer
Original Article The Prognostic Value of Ratio-Based Lymph Node Staging in Resected Non Small-Cell Lung Cancer Chen Qiu, MD,* Wei Dong, MD,* Benhua Su, MBBS, Qi Liu, MD,* and Jiajun Du, PhD Introduction:
More informationCorrelation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC. Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW
Correlation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW BACKGROUND AJCC staging 1 gives valuable prognostic information,
More informationTreatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard
Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard AATS General Thoracic Surgery Symposium May 5, 2010 Thomas A. D Amico MD Professor of Surgery, Duke University Medical
More informationLung Cancer Clinical Guidelines: Surgery
Lung Cancer Clinical Guidelines: Surgery 1 Scope of guidelines All Trusts within Manchester Cancer are expected to follow this guideline. This guideline is relevant to: Adults (18 years and older) with
More informationThe Impact of Adjuvant Chemotherapy in Pulmonary Large Cell Neuroendocrine Carcinoma (LCNC)
The Impact of Adjuvant Chemotherapy in Pulmonary Large Cell Neuroendocrine Carcinoma (LCNC) Disclosure None Background Torino, Italy LCNC Rare tumor (2% to 3% all resected primary lung cancers) Preoperative
More informationPrognostic Value of Histology in Resected Lung Cancer With Emphasis on the Relevance of the Adenocarcinoma Subtyping
GENERAL THORIC Prognostic Value of Histology in Resected Lung Cancer With Emphasis on the Relevance of the Adenocarcinoma Subtyping Marc Riquet, MD, PhD, Christophe Foucault, MD, Pascal Berna, MD, Jalal
More informationVariability in Defining T1N0 Non-Small Cell Lung Cancer Impacts Locoregional Failure and Survival
Variability in Defining T1N0 Non-Small Cell Lung Cancer Impacts Locoregional Failure and Survival Mert Saynak, MD, Jessica Hubbs, MS, Jiho Nam, MD, Lawrence B. Marks, MD, Richard H. Feins, MD, Benjamin
More informationPDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/23566
More informationAdrenal glands are a common metastatic site for non small cell lung cancer
Surgical treatment of solitary adrenal metastasis from non small cell lung cancer Olaf Mercier, MD, Elie Fadel, MD, PhD, Marc de Perrot, MD, Sacha Mussot, MD, Franco Stella, MD, Alain Chapelier, MD, PhD,
More informationPrognostic Significance of the Extent of Visceral Pleural Invasion in Completely Resected Node-Negative Non-small Cell Lung Cancer
CHEST Original Research Prognostic Significance of the Extent of Visceral Pleural Invasion in Completely Resected Node-Negative Non-small Cell Lung Cancer Jung-Jyh Hung, MD, PhD ; Wen-Juei Jeng, MD ; Wen-Hu
More informationand Strength of Recommendations
ASTRO with ASCO Qualifying Statements in Bold Italics s patients with T1-2, N0 non-small cell lung cancer who are medically operable? 1A: Patients with stage I NSCLC should be evaluated by a thoracic surgeon,
More informationSurgery for early stage NSCLC
1-3 March 2017, Manchester, UK Surgery for early stage NSCLC Dominique H. Grunenwald, MD, PhD Professor Emeritus in Thoracic and Cardiovascular surgery Pierre & Marie Curie University. Paris. France what
More informationPrognostic factors of postrecurrence survival in completely resected stage I non-small cell lung cancer with distant metastasis
< A supplementary figure and table are published online only at http://thx.bmj.com/content/ vol65/issue3. 1 Institute of Clinical Medicine, National Yang-Ming University, 2 Department of Surgery, Cathay
More informationBronchogenic Carcinoma
A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most
More informationTitle: What has changed in the surgical treatment strategies of non-small cell lung cancer in
1 Manuscript type: Original Article DOI: Title: What has changed in the surgical treatment strategies of non-small cell lung cancer in twenty years? A single centre experience Short title: Changes in the
More informationSurgical resection improves survival in pancreatic cancer patients without vascular invasion- a population based study
Original article Annals of Gastroenterology (2013) 26, 346-352 Surgical resection improves survival in pancreatic cancer patients without vascular invasion- a population based study Subhankar Chakraborty
More informationCarcinoma of the Lung in Women
Carcinoma of the Lung in Marvin M. Kirsh, M.D., Jeanne Tashian, M.A., and Herbert Sloan, M.D. ABSTRACT The 5-year survival of 293 men and of 78 women undergoing pulmonary resection and mediastinal lymph
More informationAlthough ipsilateral intrapulmonary metastasis (PM), Evaluation of TMN Classification for Lung Carcinoma With Ipsilateral Intrapulmonary Metastasis
Evaluation of TMN Classification for Lung Carcinoma With Ipsilateral Intrapulmonary Metastasis Morihito Okada, MD, Noriaki Tsubota, MD, Masahiro Yoshimura, MD, Yoshifumi Miyamoto, MD, and Reiko Nakai,
More informationThoracoscopic Lobectomy for Locally Advanced Lung Cancer. Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014
for Locally Advanced Lung Cancer Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014 Thomas A. D Amico MD Gary Hock Endowed Professor and Vice Chair of Surgery Chief Thoracic Surgery
More informationMolly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010
LSU HEALTH SCIENCES CENTER NSCLC Guidelines Feist-Weiller Cancer Center Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 Initial Evaluation/Intervention: 1. Pathology Review 2. History and Physical
More informationIn non small cell lung cancer, metastasis to lymph nodes, the N factor, is
Okada et al General Thoracic Surgery Border between N1 and N2 stations in lung carcinoma: Lessons from lymph node metastatic patterns of lower lobe tumors Morihito Okada, MD, PhD Toshihiko Sakamoto, MD,
More informationSmall cell lung cancer (SCLC), which represents 20%
ORIGINAL ARTICLES: GENERAL THORACIC Surgical Results for Small Cell Lung Cancer Based on the New TNM Staging System Masayoshi Inoue, MD, Shinichiro Miyoshi, MD, Tsutomu Yasumitsu, MD, Takashi Mori, MD,
More informationPreoperative Serum Carcinoembryonic Antigen Level is a Prognostic Factor in Women With Early Non Small-Cell Lung Cancer
Preoperative Serum Carcinoembryonic Antigen Level is a Prognostic Factor in Women With Early Non Small-Cell Lung Cancer Wen-Hu Hsu, MD, Chien-Sheng Huang, MD, Han-Shui Hsu, MD, Wen-Jen Huang, MD, Hui-Chen
More informationNumber of Metastatic Lymph Nodes in Resected Non Small Cell Lung Cancer Predicts Patient Survival
Number of Metastatic Lymph Nodes in Resected Non Small Cell Lung Cancer Predicts Patient Survival Jin Gu Lee, MD, Chang Young Lee, MD, In Kyu Park, MD, Dae Joon Kim, MD, Seong Yong Park, MD, Kil Dong Kim,
More informationThe results of the surgical treatment of stage I nonsmall
Stage I Non-Small Cell Lung Cancer: A Pragmatic Approach to Prognosis After Complete Resection Pascal Thomas, MD, FECTS, Christophe Doddoli, MD, Xavier Thirion, MD, Olivier Ghez, MD, Marie-José Payan-Defais,
More informationSagar Damle, MD University of Colorado Denver May 23, 2011
Sagar Damle, MD University of Colorado Denver May 23, 2011 We have debated many times. Here are the topics, and a recap of the last few Pre-operative nutrition Babu pro; Damle con Utility of ECMO Babu
More informationLung Cancer Epidemiology. AJCC Staging 6 th edition
Surgery for stage IIIA NSCLC? Sometimes! Anne S. Tsao, M.D. Associate Professor Director, Mesothelioma Program Director, Thoracic Chemo-Radiation Program May 7, 2011 The University of Texas MD ANDERSON
More informationLong-Term Outcome and Late Recurrence in Patients with Completely Resected Stage IA Non-small Cell Lung Cancer
ORIGINAL ARTICLE Long-Term Outcome and Late Recurrence in Patients with Completely Resected Stage IA Non-small Cell Lung Cancer Ryo Maeda, MD,* Junji Yoshida, MD,* Genichiro Ishii, MD, Keiju Aokage, MD,*
More informationStandard treatment for pulmonary metastasis of non-small
ORIGINAL ARTICLE Resection of Pulmonary Metastasis of Non-small Cell Lung Cancer Kenichi Okubo, MD,* Toru Bando, MD,* Ryo Miyahara, MD,* Hiroaki Sakai, MD,* Tsuyoshi Shoji, MD,* Makoto Sonobe, MD,* Takuji
More informationPreoperative Chemotherapy Does Not Increase Complications After Nonsmall Cell Lung Cancer Resection
Preoperative Chemotherapy Does Not Increase Complications After Nonsmall Cell Lung Cancer Resection Emilie Perrot, MD, Benoit Guibert, MD, Pierre Mulsant, MD, Sonia Blandin, MD, Isabelle Arnaud, MD, Pascal
More informationP sumed to have early lung disease with a favorable
Survival After Resection of Stage I1 Non-Small Cell Lung Cancer Nael Martini, MD, Michael E. Burt, MD, PhD, Manjit S. Bains, MD, Patricia M. McCormack, MD, Valerie W. Rusch, MD, and Robert J. Ginsberg,
More informationLung cancer is the most common overall cause of
GENERAL THORACIC Survival in Primary Lung Cancer Potentially Cured by Operation: Influence of Tumor Stage and Clinical Characteristics Gunnar Myrdal, MD, Mats Lambe, MD, PhD, Gunnar Gustafsson, MD, PhD,
More informationTreatment of oligometastatic NSCLC
Treatment of oligometastatic NSCLC Jarosław Kużdżał Department of Thoracic Surgery Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow New idea? 14 NSCLC patients with solitary extrathoracic
More informationAn Update: Lung Cancer
An Update: Lung Cancer Andy Barlow Consultant in Respiratory Medicine Lead Clinician for Lung Cancer (West Herts Hospitals NHS Trust) Lead for EBUS-Harefield Hospital (RB&HFT) Summary Lung cancer epidemiology
More informationRelevance of an Intensive Postoperative Follow-up After Surgery for Non Small Cell Lung Cancer
Relevance of an Intensive Postoperative Follow-up After Surgery for Non Small Cell Lung Cancer Virginie Westeel, MD, Didier Choma, MD, François Clément, MD, Marie-Christine Woronoff-Lemsi, PhD, Jean-François
More informationDespite their reputation of benignity, carcinoid tumors
Operative Risk and Prognostic Factors of Typical Bronchial Carcinoid Tumors Xavier Ducrocq, MD, Pascal Thomas, MD, Gilbert Massard, MD, Pierre Barsotti, MD, Roger Giudicelli, MD, Pierre Fuentes, MD, and
More informationRoutine reinforcement of bronchial stump after lobectomy or pneumonectomy with pedicled pericardial flap (PPF)
Routine reinforcement of bronchial stump after lobectomy or pneumonectomy with pedicled pericardial flap (PPF) Abstract The results of 25 cases underwent a pedicled pericardial flap coverage for the bronchial
More informationLung Cancer in Octogenarians: Factors Affecting Morbidity and Mortality After Pulmonary Resection
ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS
More informationNon-Small Cell Lung Cancer: Disease Spectrum and Management in a Tertiary Care Hospital
Non-Small Cell Lung Cancer: Disease Spectrum and Management in a Tertiary Care Hospital Muhammad Rizwan Khan,Sulaiman B. Hasan,Shahid A. Sami ( Department of Surgery, The Aga Khan University Hospital,
More informationEVIDENCE BASED MANAGEMENT OF STAGE III NSCLC MILIND BALDI
EVIDENCE BASED MANAGEMENT OF STAGE III NSCLC MILIND BALDI Overview Introduction Diagnostic work up Treatment Group 1 Group 2 Group 3 Stage III lung cancer Historically was defined as locoregionally advanced
More informationThoracic Surgery; An Overview
Thoracic Surgery What we see Thoracic Surgery; An Overview James P. Locher, Jr, MD Methodist Cardiovascular and Thoracic Surgery Lung cancer Mets Fungus and TB Lung abcess and empyema Pleural based disease
More informationThe surgeon: new surgical aproaches
The surgeon: new surgical aproaches Paul Van Schil, MD Department of Thoracic and Vascular Surgery Antwerp University, Belgium no disclosures, no conflict of interest Malignant pleural mesothelioma: clinical,
More informationCharles Mulligan, MD, FACS, FCCP 26 March 2015
Charles Mulligan, MD, FACS, FCCP 26 March 2015 Review lung cancer statistics Review the risk factors Discuss presentation and staging Discuss treatment options and outcomes Discuss the status of screening
More informationValidation of the T descriptor in the new 8th TNM classification for non-small cell lung cancer
Original Article Validation of the T descriptor in the new 8th TNM classification for non-small cell lung cancer Hee Suk Jung 1, Jin Gu Lee 2, Chang Young Lee 2, Dae Joon Kim 2, Kyung Young Chung 2 1 Department
More informationMEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER
MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER Tsuneyo Takizawa, MD a Masanori Terashima, MD a Teruaki Koike, MD a Hideki Akamatsu, MD a Yuzo
More informationCase presentation. Paul De Leyn, MD, PhD Thoracic Surgery University Hospitals Leuven Belgium
Case presentation Paul De Leyn, MD, PhD Thoracic Surgery University Hospitals Leuven Belgium Perspectives in Lung Cancer Brussels 6-7 march 2009 LEUVEN LUNG CANCER GROUP Department of Thoracic Surgery
More informationACOSOG Thoracic Committee. Kemp H. Kernstine, MD PhD
ACOSOG Thoracic Committee Kemp H. Kernstine, MD PhD ACOSOG Thoracic Committee Chair: Bryan Meyers, M.D., MPH Vice Chairs: Malcolm Brock, MD Tom DiPetrillo, M.D. Ramaswamy Govindan, M.D. Carolyn Reed, MD
More informationCheng-Yang Song, Takehiro Sakai, Daisuke Kimura, Takao Tsushima, Ikuo Fukuda
Original Article Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stage IA non-small cell lung cancer: a propensity score
More informationShort- and Long-Term Outcomes after Pneumonectomy for Primary Lung Cancer
Original Article Short- and Long-Term Outcomes after Pneumonectomy for Primary Lung Cancer Takeshi Kawaguchi, MD, Takashi Tojo, MD, Keiji Kushibe, MD, Michitaka Kimura, MD, Yoko Nagata, MD, and Shigeki
More informationVisceral Pleural Invasion Is Not Predictive of Survival in Patients With Lung Cancer and Smaller Tumor Size
GENERAL THORACIC Visceral Pleural Invasion Is Not Predictive of Survival in Patients With Lung Cancer and Smaller Tumor Size Elizabeth David, MD, Peter F. Thall, PhD, Neda Kalhor, MD, Wayne L. Hofstetter,
More informationSleeve lobectomy for lung adenocarcinoma treated with neoadjuvant afatinib
Case Report Sleeve lobectomy for lung adenocarcinoma treated with neoadjuvant afatinib Ichiro Sakanoue 1, Hiroshi Hamakawa 1, Reiko Kaji 2, Yukihiro Imai 3, Nobuyuki Katakami 2, Yutaka Takahashi 1 1 Department
More informationResected Synchronous Primary Malignant Lung Tumors: A Population-Based Study
ORIGINAL ARTICLES: SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS
More information