Abstract
Approximately 5% of the cancers involve the chest wall and spine by direct extension and remain localized at the time of diagnosis. T4 lesions invading the vertebra are considered inoperable. We reviewed a new evolution in the surgical treatment of lung cancer involving the vertebra (T4N0M0) and report preliminary results of our approach. Four patients with T4N0M0 (vertebral involvement) lung cancer underwent en bloc surgical resection of tumor between 1998 and 2002. Posterior stabilization, hemilaminectomy, and osteotomy of the involved vertebral bodies below the corresponding pedicle were performed in the prone position and then, in the lateral position, en bloc resection was completed along with the lung resection (large wedge resection or lobectomy) and involved vertebral bodies. There was no immediate postoperative mortality. Three patients died during the follow-up period at the 6th, 8th, and 14th postoperative months with a postoperative recognized metastasis. The fourth patient was in follow-up at 20 months. Although T4N0M0 (vertebral involvement) lung cancers are considered inoperable, lung resection with hemivertebrectomy of the involved vertebra after neoadjuvant chemotherapy and radiotherapy is an alternative treatment in this type of lung cancer. Staging should be made meticulously for the expected surveillance.
Résumé
Environ 5% des cancers pulmonaires touchent la paroi thoracique et la colonne vertébrale du fait de leur progression locale et ne sont pas métastatiques au diagnostic. Souvent considérées comme inopérables, les lésions T4N0M0 avec atteinte vertébrale peuvent faire l’objet de nouvelles approches chirurgicales dont nous rapportons ici notre expérience préliminaire. Quatre patients présentant un cancer broncho-pulmonaire T4N0M0 ont été traités par résection en bloc entre 1998 et 2002. Une hémi-laminectomie et une ostéotomie corporéale des vertèbres envahies associées à une stabilisation postérieure ont été réalisées en décubitus ventral; dans un deuxième temps, en décubitus latéral une résection en bloc pulmonaire (résection cunéiforme ou lobectomie) et vertébrale a été effectuée. Nous n’avons pas noté de décès post-opératoires immédiats. Trois patients sont décédés au 6è, 8è et 14è mois post-opératoires. Le quatrième patient est en vie au recul de 20 mois. Bien que les cancers pulmonaires aient longtemps été considérés inopérables, la résection pulmonaire associée à une hémi-vertébrectomie après chimiothérapie néoadjuvante et radiothérapie représente une nouvelle approche thérapeutique dans les lésions T4N0M0.
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Aydinli, U., Gebitekin, C., Bayram, S. et al. Surgical approach in T4N0M0 (vertebral involvement) lung cancer. Eur J Orthop Surg Traumatol 14, 142–146 (2004). https://doi.org/10.1007/s00590-004-0147-0
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DOI: https://doi.org/10.1007/s00590-004-0147-0