Long term results of surgery for NSCLC and aortic invasion. A multicenter retrospective cohort study. Issue 4 (April 2022)

• Record Type: Journal Article
• Authors: Campisi, Alessio; Dell'Amore, Andrea; Chen, Chunji; Gabryel, Piotr; Bertolaccini, Luca; Ciarrocchi, Angelo Paolo; Ji, Chunyu; Piwkowski, Cezary; Spaggiari, Lorenzo; Fang, Wentao; Rea, Federico
• Is Part Of: European journal of surgical oncology. Volume 48:Issue 4(2022)
• Page Start: 761
• Page End: 767
• Publication Date: 2022-04
• Subjects: Locally advanced NSCLC -- T4 tumour -- Aortic involvement -- Aorta infiltration; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.12.007
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Aortic invasion from non-small cell lung cancers (NSCLC) is a relative contraindication to surgery for oncological and technical reasons. Only a few studies have been published showing good results. Our aim was to evaluate short and long-term results of surgery for T4 NSCLC with aortic resection. Methods: This is a multicenter retrospective study including 47 patients (33 males and 14 females) who received a major lung resection with aortic surgery in our centers between January 2000 and December 2016. Results: Adenocarcinoma was diagnosed in 31 patients (66.0%). Induction therapy was used in 14 patients. Pneumonectomy was performed in 34 patients (72.3%). A subadventitial dissection with or without endovascular stent graft was carried out in 40 patients (85.1%), a cardiopulmonary bypass was used in 3 patients and left heart bypass in 4. Intraoperatively, two patients had bleeding (4.3%) and one ventricular fibrillation (2.1%). Twenty-three patients (48.9%) experienced at least one postoperative complication. A radical resection was achieved in 39 patients (83.0%). Thirty-day and 90-day mortality were 2.1% and 4.3%. One-, 3- and 5-year overall survival were 85.1%, 57.4% and 53.2%. Overall and disease-free survivals were significantly influenced by pathological lymph node status and R status that were independent predictive factors for poorer survival at the multivariate analyses. Conclusions: Aortic resection during surgery for NSCLC is a challenging situation. Nevertheless, oncologic outcomes may be favorable in selected cases justifying a risky procedure that should be performed in experienced hands.