Abstract
Background
The purpose of this study was to examine our results of combined resection of the atrium and non-small-cell lung cancer using a concurrent and continuously updated database.
Methods
A total of 35 patients underwent extended pulmonary resection with partial resection of the atrium. The main focus of the study was to define subgroups of patients who can potentially benefit from surgery.
Results
Pneumonectomy was performed in 31 cases, and the other 4 patients underwent a lesser resection. Postoperative morbidity was 20%, and the mortality rate was 9%. The median intensive care unit stay was 2 days and the hospital stay 13 days. The survival rates were 80% at 1 year, 21% at 3 years, and 16% at 5 years. The median survival of patients with low-grade tumors (G1/2) was 27 months, contrasted by only 15 months’ survival for patients with high-grade tumors (P = 0.026). Multivariate analysis indicated that completeness of resection had a significant impact on survival (P = 0.042).
Conclusions
Combined resection of lung and atrium is a complex surgical procedure, but it can be performed with fair morbidity and mortality rates, even in patients with an increased number of preoperative risk factors. Patients suffering from low-grade tumors benefit significantly from radical surgery. Future studies must define whether a multimodal therapeutic approach that includes induction therapy can prolong patient survival.
Similar content being viewed by others
References
Jett JR, Scott WJ, Rivera MP et al (2003) Guidelines on treatment of stage IIIB non-small cell lung cancer. Chest 123:221S–225S
Mountain CF (1997) Revisions in the international system for staging lung cancer. Chest 111:1710–1717
Watanabe Y (2003) TNM classification for lung cancer. Ann Thorac Cardiovasc Surg 9:343–350
Rami-Porta R, Crowley JJ, Goldstraw P (2009) The revised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg 15:4–9
William WN Jr, Lin HY, Lee JJ et al (2009) Revisiting stage IIIB and IV non-small cell lung cancer: analysis of the surveillance, epidemiology, and end results data. Chest 136:701–709
Bernard A, Bouchot O, Hagry O et al (2001) Risk analysis and long-term survival in patients undergoing resection of T4 lung cancer. Eur J Cardiothorac Surg 20:344–349
Bobbio A, Carbognani P, Grapeggia M et al (2004) Surgical outcome of combined pulmonary and atrial resection for lung cancer. Thorac Cardiovasc Surg 52:180–182
Fukuse T, Wada H, Hitomi S (1997) Extended operation for non-small cell lung cancer invading great vessels and left atrium. Eur J Cardiothorac Surg 11:664–669
Ratto GB, Costa R, Vassallo G et al (2004) Twelve-year experience with left atrial resection in the treatment of non-small cell lung cancer. Ann Thorac Surg 78:234–237
Spaggiari L, D’Aluto M, Veronesi G et al (2005) Extended pneumonectomy with partial resection of the left atrium, without cardiopulmonary bypass, for lung cancer. Ann Thorac Surg 79:234–240
Tsuchiya R, Asamura H, Kondo H et al (1994) Extended resection of the left atrium, great vessels, or both for lung cancer. Ann Thorac Surg 57:960–965
Kühnl A, Hocaoglu Y, Herzog M et al (2007) The University of Munich lung cancer group database: design, profile of cohort and outcome analysis. Eur J Med Res 12:520–526
Gallo AE, Donington JS (2007) The role of surgery in the treatment of stage III non-small-cell lung cancer. Curr Oncol Rep 9:247–254
Roy MS, Donington JS (2007) Management of locally advanced non small cell lung cancer from a surgical perspective. Curr Treat Options Oncol 8:1–14
Gardner RM (1988) Standardization of spirometry: a summary of recommendations from the American Thoracic Society: the 1987 update. Ann Intern Med 108:217–220
Licker MJ, Widikker I, Robert J et al (2006) Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg 81:1830–1837
Osaki T, Sugio K, Hanagiri T et al (2003) Survival and prognostic factors of surgically resected T4 non-small cell lung cancer. Ann Thorac Surg 75:1745–1751 (discussion 1751)
Shimizu J, Hirano Y, Ishida Y et al (2004) Advanced lung cancer invading the left atrium wall treated with pneumonectomy and combined resection of the left atrium using stapling devices: report of two cases. Ann Thorac Cardiovasc Surg 10:113–117
Doddoli C, Rollet G, Thomas P et al (2001) Is lung cancer surgery justified in patients with direct mediastinal invasion? Eur J Cardiothorac Surg 20:339–343
Mina K, Byrne MJ, Ryan G et al (2004) Surgical management of lung cancer in Western Australia in 1996 and its outcomes. ANZ J Surg 74:1076–1081
Izbicki JR, Knoefel WT, Passlick B et al (1995) Risk analysis and long-term survival in patients undergoing extended resection of locally advanced lung cancer. J Thorac Cardiovasc Surg 110:386–395
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuehnl, A., Lindner, M., Hornung, HM. et al. Atrial Resection for Lung Cancer: Morbidity, Mortality, and Long-Term Follow-up. World J Surg 34, 2233–2239 (2010). https://doi.org/10.1007/s00268-010-0596-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-010-0596-z