Abstract
Objective: We evaluated survival after extended surgery in patients with non-small-cell lung cancer and the effects of induction therapy on results and complications.Subjects and Methods: Between April 1987 and March 1998, 127 patients with pathological T3 (pT3) or T4 (pT4) non-small-cell lung cancer underwent extended surgery combined with resection of neighboring organs. Of these, 35 received induction therapy. In the remaining 92, surgery preceded other therapy. Long-term results and postoperative respiratory complications were analyzed and compared between the patients with and without induction therapy.Results: Overall 5-year survival after extended surgery was 37%. Five-year survival rates in the pT3 was 41% and that in the pT4 group 28% (p = 0.030). Five-year survivalrate in the pNO-1 was 46% and that in the pN2-3 group 26% (p = 0.003). No significant difference was observed in survival curves between patients with and without induction therapy. Induction therapy responders showed better survival than nonresponders. To prevent postoperative fatal complications due to bronchopleural fistula, we prophylactically covered the bronchial stump using autologous tissue in 31 induction therapy patients, and no mortality due to complications was seen in this group.Conclusion: Long-term survival after extended surgery was observed in pT3 and pT4 patients, especially among those with a pN0-l status. Induction therapy responders may be considered good candidates for extended surgery because of the favorable prognosis in contrast to that for nonresponders.
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Rosell R, Gomez-Condina J, Camps C, Maestre J, Padille J, Canto, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. New Eng J Med 1994; 330: 153–8.
Roth JA, Fossella F, Komaki R, Ryan MB, Putnam JB, Lee JS Jr, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst 1994; 86: 673–80.
Kodama K, Doi O, Kabuto T, Akita N, Terasawa T, Tateishi R. Clinical evaluation for extended surgery to the lung cancer involving surrounding structures. Jap J Thorac Cardio vase Surg 1985; 33: 217–23.
Kodama K, Doi O, Tatsuta M, Kurokawa E. Extensive surgery for lung cancer: effect on various adjacent structures. J Jap Assoc Chest Surg 1988; 2: 270–9.
Roth JA, Atkinson EN, Fossella F, Komaki R, Ryan MB, Putnam JB, et al. Long-term follow-up of patients enrolled in a randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. Lung Cancer 1998; 21: 1–6.
Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. New Eng J Med 1998; 338: 1798–804.
Kodama K, Doi O, Tatsuta M, Kobayashi T, Fudemoto Y, Kurokawa E. Four operative cases of lung carcinoma with intra-atrial extension via the pulmonary vein. J Jap Surg Sosiety 1988; 89: 2010–8.
Kodama K, Doi O, Tatsuta M. Unusual extension of lung cancer into the left atrium via the pulmonary vein. Int Surg 1990; 75: 22–6.
Wright CD, Wain JC, Mathisen DJ, Grillo HC: Postpneumonectomy bronchopleural fistula after sutured bronchial closure: incidence, risk factors, and management. J Thorac Cardiovasc Surg 1996; 112: 1367–71.
Muehrcke DD, Grillo HC, Mathisen DJ: Reconstructive airway operation after irradiation. Ann Thorac Surg 1995; 59: 14–8.
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Read at the Fifty-fist Annual Meeting of the Japanese Association for Thoracic Surgery, Symposium, Tokyo, October 2–4, 1998.
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Kodama, K., Higashiyama, M., Yokouchi, H. et al. Survival and postoperative complications after extended surgery for non-small-cell lung cancer. Jpn J Thorac Caridovasc Surg 47, 546–551 (1999). https://doi.org/10.1007/BF03218060
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DOI: https://doi.org/10.1007/BF03218060