Extended operation for non-small cell lung cancer invading great vessels and left atrium

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Abstract
OBJECTIVE: We analyzed the results of surgical treatment in patientswith non-small cell lung cancer invading the great vessels (GV) and leftatrium (LA) by direct extension and without distant metastases. METHODS:From 1976 to 1993, 42 patients (37/male, 5/female) with lung cancerinvading the GV and LA were treated surgically, 13 had invasion of thesuperior vena cava and innominate vein, 15 of the aorta and subclavianartery, and 14 of the left atrium. In all 42 the diagnosis was confirmed bypathological examination. Surgical resection included pneumonectomy (16patients) and lobectomy (26 patients). The histologic type was squamouscell carcinoma in 27 patients, adenocarcinoma in 12, and large cellcarcinoma in 3. Preoperatively, 13 patients were treated with radiation andchemotherapy. Postoperatively, further treatment was given to 22 patients.All were staged according to the international TNM staging system. Survivalwas calculated by the Kaplan-Meler method. RESULTS: A total of 15 patientsunderwent complete resection. Reliability of clinical N factor was 80%. Theoverall survival was 17% at 3 years (median survival time (MST), 14months). The operative mortality was 2.4%. Patients with lung cancerinvading GV (MST, 19 months) had significantly longer survival than didthose with cancer invading LA (MST, 10 months, P = 0.036). There weresignificant prognostic differences between N0-1 and N2-3 (MST, 22 months;MST, 9 months, respectively, P = 0.0013). Cox regression analysisidentified pathological N factor, completeness of resection, and pre- andpostoperative radiotherapy as important in affecting survival. CONCLUSIONS:We conclude that patients with pathological N0-1 non-small cell lung cancerinvading great vessels can achieve long-term survival with adequatesurgical treatment.