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New Therapeutic Strategies in Lung Cancers pp 95–116Cite as

Surgery of Advanced Tumors

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Abstract

Lung cancer remains the most fatal cancer worldwide with over 1,300,000 deaths estimated for the year 2000 (Murray CJL, Lopez AD, editors. The global burden of disease: a comprehensive assessment of mortality and disability from disease injuries and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press; 1996; Parker et al. CA Cancer J Clin 47:5–27, 1997). Only 10 % of patients with lung cancers diagnosed in the European population are alive at 5 years, a figure that compares quite poorly with the 50 and 70 % 5-year survival rates for colon and breast cancer, respectively (Berrino F, Capocaccia R, Esteve J, editors. Survival of cancer patients in Europe-the EUROCARE 2 study, vol 151. IARC Scientific Publications; 1999. p. 1–572). The former version of TNM classification to direct treatment eliminated some patients from potentially curative surgery; thus stage IIIB included T1N3 which is not curable by surgery as well as T4N0; in the actual TNM classification, T4NO tumors are now classified stage IIIA confirming that some of these locally advanced tumors are amenable to surgical resection and possible long-term survival (Goldstraw et al. J Thorac Oncol 2:706–14, 2007). Locally advanced lung cancer encompasses T3 tumors with direct extension into the chest wall, diaphragm, or mediastinal pleura or within 2 cm of the carina and nearly all T4 tumors invading the mediastinum, heart, great vessels, trachea, esophagus, vertebral body, or carina. Extended resections for tumors that are locally advanced according to T status imply that surgical resection is being performed under circumstances that are technically challenging and beyond the usual scope of an operation for lung cancer.

Likewise, the development of preoperative chemotherapy or chemoradiotherapy is said to make curative treatment possible for tumors that are locally advanced according to N status. However, surgery after induction therapy poses special perioperative risks and technical challenges because it is often difficult to distinguish the difference between sclerotic tissue and tumor margins; moreover, the “downstaging” phenomenon does not occur with a high frequency. Patients with T4 tumors with N0 or N1 disease should benefit most from surgery because these tumors are often more local-regionally than systemically aggressive.

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Authors and Affiliations

  1. Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, 133 Avenue de la Resistance, Le Plessis Robinson, 92350, France

    Philippe G. Dartevelle MD & Sacha Mussot MD, MSc

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  1. Philippe G. Dartevelle MD
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  2. Sacha Mussot MD, MSc
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Correspondence to Sacha Mussot MD, MSc .

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  1. Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Solange Peters

  2. Pathologie thoracique, Institut Gustave Roussy, Villejuif, France

    Benjamin Besse

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Dartevelle, P.G., Mussot, S. (2015). Surgery of Advanced Tumors. In: Peters, S., Besse, B. (eds) New Therapeutic Strategies in Lung Cancers. Springer, Cham. https://doi.org/10.1007/978-3-319-06062-0_7

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