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Atrial resection for T4 non-small cell lung cancer with left atrium involvement: a systematic review and meta-analysis of survival

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Abstract

Purpose

Extended resection for non-small cell lung cancer (NSCLC) with T4 left atrium involvement is controversial. We performed a systematic review and meta-analysis to evaluate the short- and long-term outcomes of this treatment strategy.

Methods

We searched the PubMed database for studies on atrial resection in NSCLC patients. The primary investigated outcome was the effectiveness of the surgery represented by survival data and the secondary outcomes were postoperative morbidity, mortality, and recurrence.

Results

Our search identified 18 eligible studies including a total of 483 patients. Eleven studies reported median overall survival and 17 studies reported overall survival rates. The estimated pooled 1, 3, 5-year overall survival rates were 69.1% (95% CI 61.7–76.0%), 21.5% (95% CI 12.3–32.3%), and 19.9% (95% CI 13.9–26.6%), respectively. The median overall survival was 24 months (95% CI 17.7–27 months). Most studies reported significant associations between better survival and N0/1 status, complete resection status, and neoadjuvant therapy.

Conclusion

Extended lung resection, including the left atrium, for NSCLC is feasible with acceptable morbidity and mortality when complete resection is achieved. Lymph node N0/1 status coupled with the use of neoadjuvant therapies is associated with better outcomes.

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Abbreviations

NSCLC:

Non-small cell lung cancer

LA:

Left atrium

OS:

Overall survival

mOS:

Median overall survival

R0:

No identifiable tumor remaining, negative surgical margins

R1:

Microscopically positive margins but no visible tumor remaining

R2:

Gross (visible or palpable) tumor remaining

AJCC:

American Joint Committee on Cancer

UICC:

Union for International Cancer Control

DFS:

Disease-free survival

VAM:

Video-assisted mediastinoscopy

NCCN:

National Comprehensive Cancer Network

CPB:

Cardiopulmonary bypass

FEV1:

Forced expiratory volume in one second

DLCO:

Diffusing capacity for carbon monoxide

PPO:

Predicted postoperative

VO2max:

Maximal oxygen consumption

ThRCRI:

Thoracic revised cardiac risk index

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Acknowledgements

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Funding

None declared.

Author information

Authors and Affiliations

  1. Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan

    Shadi Hamouri & Sebawe Syaj

  2. Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan

    Nasr Alrabadi

  3. Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan

    Hassan Abushukair, Obada Ababneh, Leen Al-Kraimeen & Majd Al-Sous

  4. Thoracic Surgery Department, Thoracic Center Ruhrgebiet in Herne, Herne, Germany

    Erich Hecker

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  1. Shadi Hamouri
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Contributions

SH, NA, and EH: Conceptualization, Methodology, Supervision, writing – original draft, Writing – review & editing. SS: Data curation, Formal Analysis, Investigation, Software, Writing – original draft. HA, OA, LA, and MA: Data curation, Investigation, Methodology, Resources, Validation, Writing – original draft.

Corresponding author

Correspondence to Shadi Hamouri.

Ethics declarations

Conflict of interest

None declared.

Ethical standards

Ethical approval was obtained from the Institutional Review Board (IRB) of the hospital, committed to the scientific research policy at our institution. This study was conducted following the 1975 Helsinki declaration, as revised in 2008 and its later amendments or comparable ethical standards.

Registration

This review was not registered, and a protocol was not prepared. The code used in generating forest plots is available upon request.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 kb)

Supplementary file2 (DOCX 47 KB)

Supplementary file3 (DOCX 40 KB)

595_2021_2446_MOESM4_ESM.jpg

Supplementary file4 (JPG 4891 KB) Fig. S1: 5-year overall survival (excluding the studies by Fukuse 1997 and Takahashi 1999 documenting 0%)

595_2021_2446_MOESM5_ESM.jpg

Supplementary file5 (JPG 3797 KB) Fig. S2: 3-year overall survival (excluding the studies of Fukuse 1997 and Takahashi 1999 documenting 0%)

595_2021_2446_MOESM6_ESM.jpg

Supplementary file6 (JPG 4641 KB) Fig. S3: A bar plot demonstrating 5-, 3-, and 1-year overall survival, sorted by the percentage of patients treated preoperatively with chemotherapy, radiotherapy, or chemoradiotherapy

595_2021_2446_MOESM7_ESM.jpg

Supplementary file7 (JPG 4471 KB) Fig. S4: A bar plot demonstrating 5-, 3-, and 1-year overall survival, sorted by the percentage of patients treated postoperatively with chemotherapy, radiotherapy, or chemoradiotherapy

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Hamouri, S., Alrabadi, N., Syaj, S. et al. Atrial resection for T4 non-small cell lung cancer with left atrium involvement: a systematic review and meta-analysis of survival. Surg Today 53, 279–292 (2023). https://doi.org/10.1007/s00595-021-02446-8

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