title: Extended resection of the left atrium, great vessels, or both for lung cancer.
abstract: One hundred one patients with locally advanced lung cancer underwent combined resection of the lung and the left atrium with or without the great vessels. A single additional organ was resected in 92 patients, two organs in 8 patients, and three organs in 1 patient. The left atrium was resected in 44 patients, the superior vena cava in 32, the adventitia of the aorta in 21, the aorta in 7, and the pulmonary artery in 7. The most important factors affecting survival defined by multivariate analysis were postoperative pneumonia, complete resection, postoperative bleeding, and lymph node metastasis (p < 0.05). Thirteen patients survived 3 years or more and 10 of the 13 survived 5 years or more. The 5-year survival rate for all patients, including 8 with operative death, was 13%, and the median survival time was 9.2 months. The 5-year survival and median survival time were 19% and 13.8 months after complete resection and 0% and 6.5 months after incomplete resection (p < 0.01). The 5-year survival and median survival time for patients with pathologic stage IIIA, IIIB, and IV were 16.8% and 16.8 months; 18.3% and 9.8 months; and 0% and 5.4 months, respectively. There was a significant difference between stages IIIA plus IIIB and stage IV (p < 0.05). The 5-year survival after left atrium resection was 22%. Extended resection was worthwhile for the patients undergoing complete resection and without postoperative complications.
authors.affiliation: Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Tsuchiya
authors.forename: H
authors.initials: H
authors.lastname: Asamura
authors.forename: H
authors.initials: H
authors.lastname: Kondo
authors.forename: T
authors.initials: T
authors.lastname: Goya
authors.forename: T
authors.initials: T
authors.lastname: Naruke
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001018:Aortic Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006338:Heart Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014683:Vena Cava, Superior