|
|
“Extended pneumonectomy” for broncogenic carcinoma: surgical and survival outcomes.
A. Borri, D. Galetta, F. Leo, F. Petrella, R. Gasparri, P. Scanagatta, D. Radice, G. Veronesi, L. Spaggiari. Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy,
BACKGROUND: Postoperative morbidity and mortality after standard pneumonectomy range from 2,8 to 43%, and 2.9 to 12%, respectively. However, the impact of “extended pneumonectomy” (EP) on postoperative period and the oncological advantage of such resection is unclear. We review our experience in the use of EP in locally advanced lung cancer with particular regard to postoperative outcome and long term results.
METHODS: We consider “extended pneumonectomy” the full resection of the lung associated to the resection of mediastinal organs (carina, superior vena cava, left atrium, aorta, esophagous) or chest wall/diaphragm structures. Kaplan-Meier and log-rank test were used to analyse survival data.
RESULTS: From January 1998 to March 2005, 47 patients underwent EP for NSCLC. Pneumonectomy was extended to chest wall/diaphragm, left atrium, SVC, carina, SVC and carina, aorta and oesophagus in 6, 15, 4,4,9,7,1 patients respectively. Thirty-eight patients (80.8%) underwent induction chemotherapy. Overall postoperative morbidity was 57,4% with a major complication rate of 17%. Thirty-day and 60-day mortality rate were 4,2%, and 8.5%, respectively. Complete resection was achieved in 87% of cases (n=41). Overall 5-year probability of survival was 22,8% with a median survival of 16 months. Neither postoperative outcome nor survival were significantly influenced by the type of extended pneumonectomy.
CONCLUSIONS: EP is a feasible procedure in selected patients, with acceptable postoperative morbidity and mortality. Complete resection is achieved in an high number of patients, and using severe selection criteria some patients could reach permanent cure.
Back to 32nd Annual Meeting
Back to Program Outline
|
