Combined thoracic aortic or upper digestive tract resection for lung cancer and malignant mediastinal tumor.
OBJECTIVE
We studied possible indications and combined resection in patients with lung cancer and mediastinal tumors requiring combined thoracic aortic or upper digestive tract resection.


METHODS
Ten patients with lung cancer and malignant mediastinal tumors (9 men and 1 woman aged 39 to 72 years; mean: 60.5) underwent combined aortic or upper digestive tract resection.


RESULTS
Five--3 [corrected] with primary lung cancer, 1 with thymic cancer, and 1 with liposarcoma--, underwent combined aortic resection. In 2 each, lung cancer and malignant mediastinal tumor had infiltrated the thoracic aorta. The remaining case of lung cancer was complicated by aortic aneurysm in the distal arch. Cardiopulmonary bypass was conducted in 4, and selective cerebral perfusion in 2. Three patients are alive after 11, 22, and 61 months without disease recurrence. Those undergoing combined upper digestive tract resection all had lung cancer, with 4 having tumors infiltrating the esophagus or corpus ventriculi. The remaining patient had both lung and esophageal cancer. The patient treated with combined corpus ventriculi resection has survived 24 months and the patient treated with combined esophageal resection has survived 12 months without disease recurrence. The 1-year survival rate was 60%, 2-year 23%, and 3-year 23%. Prognosis was generally poor with the longest survival 13 months with N2 lung cancer.


CONCLUSIONS
In combined resection due to malignant mediastinal tumor, T4N0-1 lung cancer, or diseases such as aortic aneurysm, prognosis can be expected to improve. Despite the often poor prognosis in T4N2 lung cancer, surgical intervention may be indicated to avoid complications due to tumor invasion and to lengthen survival and improve quality of life.
Oyama
K
K
Department of SurgeryI, Tokyo Women's Medical University, Japan.
Onuki
T
T
Mae
M
M
Adachi
T
T
Kanzaki
M
M
Murasugi
M
M
Sone
Y
Y
Kei
J
J
Yokoyama
M
M
Nitta
S
S
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery; D002315:Cardiopulmonary Bypass; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D019043:Vascular Neoplasms / Q000473:pathology / Q000601:surgery