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Role of surgery in multi-modality treatment for carcinomatous pleuritis in patients with non-small cell lung cancer

Surgery Today volume 45, pages 197–202 (2015)Cite this article

Abstract

Objective

To evaluate the role of surgery in the treatment of the patients with non-small cell lung cancer with pleural dissemination.

Methods

The clinical records of 25 patients (mean age 69 years) diagnosed with carcinomatous pleuritis during a thoracotomy by pathological examination and followed by surgery between 1994 and 2012 were reviewed. The treatment modality, including surgery, the clinicopathologic characteristics and 5-year survival were analyzed.

Results

There were 16 adenocarcinomas, 6 squamous cell carcinomas and 3 large cell carcinomas. Surgery included resection of the main tumor by partial resection in 10 cases, segmentectomy in 2 cases, lobar resection in 12 cases and bilobectomy in 1 case. Intrathoracic irrigation was performed in 20 cases. The pathological N status was N0/N1/N2/Nx: 10/6/7/2. Fifteen patients received adjuvant therapy. The overall 5-year survival rate was 22.2 %. The 5-year survival rates of the N0, N1 and N2 groups were 36.0, 16.7 and 14.3 %, respectively (p = 0.0068). Nine patients lived more than 3 years including 5 in N0, 3 in N1 and 1 in N2.

Conclusions

Surgery should not be excluded from the multi-modality treatment of patients with carcinomatous pleuritis because there are some patients who could benefit from surgery especially if they are in N0 status.

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References

  1. Rami-Porta R, Goldstraw P. The revised TNM staging system. Ann Thorac Cardiovasc Surg. 2009;15:4–9.

    PubMed  Google Scholar 

  2. Reshad K, Inui K, Takeuchi Y, Takahashi Y, Hitomi S. Treatment of malignant pleural effusion. Chest. 1985;88:393–7.

    CAS  PubMed  Article  Google Scholar 

  3. Ichinose Y, Tsuchiya R, Koike T, Kuwahara O, Nakagawa K, Yamato Y, et al. and the Japan Clinical Oncology Group. The prognosis of patients with non-small cell lung cancer found to have carcinomatous pleuritis at thoracotomy. Surg Today. 2000;30:1062–6.

  4. Sawabata N, Matsumura A, Motohiro A, Osaka Y, Gennga K, et al. for The Japan National Chest Hospital Study Group for Lung Cancer. Malignant minor pleural effusion detected on thoracotomy for patients with non-small cell lung cancer: Is tumor resection beneficial for prognosis? Ann Thorac Surg. 2002;73:412–5.

  5. Ichinose Y, Tsuchiya R, Koike T, Kuwahara O, Nakagawa K, Yamato Y, et al. and the Japan Clinical Oncology Group. Prognosis of resected non-small cell lung cancer patients with carcinomatous pleuritis of minimal disease. Lung Cancer. 2001;32:55–60.

  6. Riquet M. Lung cancer with pleural dissemination: why not operation? Ann Thorac Surg. 2002;74:1750.

    PubMed  Article  Google Scholar 

  7. Ohta Y, Shimizu Y, Matsumoto Tamura M, Oda M, Watanabe G. Retrospective review of lung cancer patients with pleural dissemination after limited operations combined with parietal pleurectomy. J Surg Oncol. 2005;91:237–42.

    PubMed  Article  Google Scholar 

  8. The Japan Lung Cancer Society. General rule for clinical and pathological record of lung cancer (in Japanese). 7th ed; 2010. p. 50–1.

  9. Kodama K, Doi O, Higashiyama M, Yokouchi H, Tatsuta M. Long-term results of postoperative intrathoracic chemo-thermotherapy for lung cancer with pleural dissemination. Cancer. 1993;72(2):426–31.

    CAS  PubMed  Article  Google Scholar 

  10. Yokoi K, Matsuguma H, Anraku M. Extrapleural pneumonectomy for lung cancer with carcinomatous pleuritis. J Thorac Cardiovasc Surg. 2002;123(1):184–5.

    PubMed  Article  Google Scholar 

  11. Pagan V, Fontana P, Zaccaria A, Lo Giudice F, Oniga F. Surgical outcome of lung cancer patients with carcinomatous pleuritis. Chir Ital. 2005;57(6):703–8.

    PubMed  Google Scholar 

  12. Mordant P, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. Surgery for metastatic pleural extension of non-small-cell lung cancer. Eur J Cardiothorac Surg. 2011;40(6):1444–9.

    PubMed  Google Scholar 

  13. Manac’h D, Riquet M, Medioni J, Le Pimpec-Barthes F, Dujon A, Danel C. Visceral pleura invasion by non-small cell lung cancer: an underrated bad prognostic factor. Ann Thorac Surg. 2001;71(4):1088–93.

    PubMed  Article  Google Scholar 

  14. Okada M, Sakamoto T, Nishio W, Uchino K, Tsuboshima K, Tsubota N. Pleural lavage cytology in non-small cell lung cancer: lessons from 1000 consecutive resections. J Thorac Cardiovasc Surg. 2003;126(6):1911–5.

    PubMed  Article  Google Scholar 

  15. Buhr J, Berghäuser KH, Gonner S, Kelm C, Burkhardt EA, Padberg WM. The prognostic significance of tumor cell detection in intraoperative pleural lavage and lung tissue cultures for patients with lung cancer. J Thorac Cardiovasc Surg. 1997;113(4):683–90.

    CAS  PubMed  Article  Google Scholar 

  16. Kondo H, Asamura H, Suemasu K, Goya T, Tsuchiya R, Naruke T, et al. Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer. J Thorac Cardiovasc Surg. 1993;106(6):1092–7.

    CAS  PubMed  Google Scholar 

  17. Buhr J, Berghäuser KH, Morr H, Dobroschke J, Ebner HJ. Tumor cells in intraoperative pleural lavage. An indicator for the poor prognosis of bronchogenic carcinoma. Cancer. 1990;65(8):1801–4.

    CAS  PubMed  Article  Google Scholar 

  18. Miura T, Shimada T, Tanaka K, Chujo M, Uchida Y. Lymphatic drainage of carbon particles injected into the pleural cavity of the monkey, as studied by video-assisted thoracoscopy and electron microscopy. J Thorac Cardiovasc Surg. 2000;120(3):437–47.

    CAS  PubMed  Article  Google Scholar 

  19. Higashiyama M, Oda K, Okami J, Maeda J, Kodama K, Takenaka A, et al. Prognostic value of intraoperative pleural lavage cytology for lung cancer without carcinomatous pleuritis: importance in patients with during long-term follow-up. Eur J Cardiothorac Surg. 2009;35(2):337–42.

    PubMed  Article  Google Scholar 

  20. Aokage K, Yoshida J, Ishii G, Enatsu S, Hishida T, Nishimura M, et al. The impact on survival of positive intraoperative pleural lavage cytology in patients with non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2010;139(5):1246–52.

    PubMed  Article  Google Scholar 

  21. Satoh Y, Hoshi R, Ishikawa Y, Horai T, Okumura S, Nakagawa K. Recurrence patterns in patients with early stage non-small cell lung cancers undergoing positive pleural lavage cytology. Ann Thorac Surg. 2007;83(1):197–202.

    PubMed  Article  Google Scholar 

  22. Janjigian YY, Park BJ, Zakowski MF, Ladanyi M, Pao W, D’Angelo SP, et al. Impact on disease-free survival of adjuvant erlotinib or gefitinib in patients with resected lung adenocarcinomas that harbor EGFR mutations. J Thorac Oncol. 2011;6(3):569–75.

    PubMed Central  PubMed  Article  Google Scholar 

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Acknowledgments

This study received no financial support from any funds or institutes.

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Affiliations

  1. Department of General Thoracic, Breast and Endocrine Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan

    Tetsuhiko Go, Noriyuki Misaki, Natsumi Matsuura, Sung Soo Chang, Shintarou Tarumi & Hiroyasu Yokomise

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  1. Tetsuhiko Go
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  2. Noriyuki Misaki
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  3. Natsumi Matsuura
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  4. Sung Soo Chang
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  5. Shintarou Tarumi
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  6. Hiroyasu Yokomise
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Correspondence to Tetsuhiko Go.

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Go, T., Misaki, N., Matsuura, N. et al. Role of surgery in multi-modality treatment for carcinomatous pleuritis in patients with non-small cell lung cancer. Surg Today 45, 197–202 (2015). https://doi.org/10.1007/s00595-014-0987-0

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  • DOI: https://doi.org/10.1007/s00595-014-0987-0

Keywords

  • Lung cancer
  • Pleural dissemination
  • Surgery