PMID- 23566644
OWN - NLM
STAT- MEDLINE
DCOM- 20130719
LR  - 20220321
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 95
IP  - 5
DP  - 2013 May
TI  - Survival after extended resection for mediastinal advanced lung cancer: lessons 
      learned on 167 consecutive cases.
PG  - 1717-25
LID - S0003-4975(13)00492-X [pii]
LID - 10.1016/j.athoracsur.2013.01.088 [doi]
AB  - BACKGROUND: Extended resections (ER) for lung cancer may improve survival in 
      selected patients. However, analysis on large series is still lacking. We 
      reviewed our experience to identify prognostic factors useful for patient 
      selection. METHODS: Between 1998 and 2010, 167 patients with involvement of one 
      or more mediastinal organs underwent operations with the intent to perform ER. At 
      thoracotomy, 42 patients (25%) were considered unresectable (explorative 
      thoracotomy [ET]), and 125 (75%) underwent ER. The types of ER were superior vena 
      cava in 43 patients (34.4%), carina in 33 (26.4%), combined with superior vena 
      cava in 18 (14.4%), with the left atrium in 35 (28%), and with the aorta in 14 
      (11.2%). We excluded Pancoast tumors and vertebral resections. The minimum 
      follow-up was 6 months. Kaplan-Meier method and log-rank test were used for 
      statistical analysis of survival. RESULTS: There were 136 men (81.4%), with mean 
      age of 63 years (range, 36 to 81 years). Of the 167 patients, induction 
      chemotherapy was administered in 119 (71.3%), including 34 ET patients (81%) and 
      85 ER patients (68%). Complete resection was achieved in 106 patients (84.8%). 
      The overall 5-year survival was 23% (27% in ER and 13% in ET, p = 0.41). Overall 
      30-day mortality was 4.8% and morbidity was 34.1%. Factors affecting survival 
      were complete resection (p < 0.01), pStage 0-I-II disease (p < 0.0007), and age 
      younger than 60 years (p < 0.01). CONCLUSIONS: ER for lung cancer invading 
      mediastinal organs could improve long-term survival (46% at 5-years in pN0). The 
      best surgical candidates are young patients without lymph nodes involvement who 
      undergo radical resection. Multimodality treatment is suggested in case of 
      mediastinal lymph node involvement.
CI  - Copyright (c) 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Spaggiari, Lorenzo
AU  - Spaggiari L
AD  - Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy. 
      lorenzo.spaggiari@ieo.it
FAU - Tessitore, Adele
AU  - Tessitore A
FAU - Casiraghi, Monica
AU  - Casiraghi M
FAU - Guarize, Juliana
AU  - Guarize J
FAU - Solli, Piergiorgio
AU  - Solli P
FAU - Borri, Alessandro
AU  - Borri A
FAU - Gasparri, Roberto
AU  - Gasparri R
FAU - Petrella, Francesco
AU  - Petrella F
FAU - Maisonneuve, Patrick
AU  - Maisonneuve P
FAU - Galetta, Domenico
AU  - Galetta D
LA  - eng
PT  - Journal Article
DEP - 20130406
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - Lung Neoplasms/mortality/pathology/*surgery
MH  - Lymph Nodes/pathology
MH  - Male
MH  - Mediastinum/*pathology
MH  - Middle Aged
MH  - Morbidity
MH  - Neoplasm Staging
EDAT- 2013/04/10 06:00
MHDA- 2013/07/20 06:00
CRDT- 2013/04/10 06:00
PHST- 2012/04/20 00:00 [received]
PHST- 2013/01/17 00:00 [revised]
PHST- 2013/01/29 00:00 [accepted]
PHST- 2013/04/10 06:00 [entrez]
PHST- 2013/04/10 06:00 [pubmed]
PHST- 2013/07/20 06:00 [medline]
AID - S0003-4975(13)00492-X [pii]
AID - 10.1016/j.athoracsur.2013.01.088 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2013 May;95(5):1717-25. doi: 10.1016/j.athoracsur.2013.01.088. 
      Epub 2013 Apr 6.