Author of

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  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P1.07-038 - Surgical Treatment for T4 Non-small Cell Lung Cancer Invading Mediastinal Structures (ID 2642)

    09:30 - 09:30  |  Author(s): H. Baek
    • Abstract

    Background
    Non-small cell lung cancer (NSCLC) with invasion of mediastinal structures is now classified as stage IIIA or IIIB according to N stages, and has been considered surgically unfavorable. However, in a selected group of these patients, better results have been reported after surgical resection compared to non-surgical group. The aim of this study is to evaluate the role of surgical resection in treatment of mediastinal T4 NSCLC and risk factors that should be considerated.

    Methods
    Among 2215 patients who underwent surgical intervention for non-small cell lung cancer from Aug 1987 to Dec 2011 in Korea cancer center hospital, 119 patients had an invasion of T4 mediastinal structures. Their medical records in Data Base were reviewed, and they were followed up completely until Apr 2013. Surgical results and prognostic factors of NSCLC invading mediastinal structures were evaluated retrospectively.

    Results
    Lung cancer was resected completely in 83 patients (69.7%, 83/119). Lobectomy was performed in 25 patients and pneumonectomy in 58. The mediastinal structures invaded by primary tumor were great vessels (44.6%), heart (15.7%), vagus nerve (12.1%), carina (8.4%), esophagus (9.6%), and vertebral body (9.6%). Nodal status was N0 in 16, N1 in 28, and N2 in 39. Neoadjuvant therapy was executed in 11 (13.25%) and adjuvant therapy was added in 53 (63.9%) out of complete resection group (n=83). Complication rate was 30.1% and operative mortality was 8.4% in complete resection group. Median and 5 year overall survival including operative mortality was 20.1 months and 22.7% in complete resection group (n=83), and 6.1months and 0% in exploration only group (n=36, p=.001). Overall 5year survival rates of N2(-) and N2(+) group were 32.8% and 9.3% respectively (p=.002). There was no survival difference between T4 N2(-) group and other IIIA stage group. Mediastinal structure invaded, old age, gender, neoadjuvant and adjuvant chemotherapy showed no significant prognostic difference.

    Conclusion
    The operative risk of NSCLC invading mediastinal structures was high because of high rate of pneumonectomy and wider range of resection, however it can be acceptable. Long-term result of complete resection was favorable in selected group. Aggressive surgical approach is recommended in well selected patients with good performance and N2(-) in mediastinal T4 group. Stage grouping of T4N2(-) patients in AJCC 7th edition is thought to be adequate when complete resection was likely.