title: Long-term outcome after en bloc resection of non-small-cell lung cancer invading the pulmonary sulcus and spine.
abstract: BACKGROUND
  Lung cancer invading the spine historically has been considered unresectable. Nevertheless, considerable surgical progress has been made since the 1990s potentially allowing for curative resection. Here, we describe our surgical experience and long-term results.
  
  
  METHODS
  All patients who underwent en bloc resection of non-small-cell lung cancer invading the pulmonary sulcus and spine between 1991 and 2012 were retrospectively reviewed.
  
  
  RESULTS
  Forty-eight patients were included. Induction therapy consisted mostly of two cycles of cisplatin-etoposide and 45 Gy of concurrent radiation. All tumors were resected en bloc, including the lung, spine, and chest wall. Total vertebrectomy, hemivertebrectomy, and partial vertebrectomy were required in 10 patients (21%), 31 patients (64%), and seven patients (15%), respectively. Complete resection was achieved in 42 patients (88%). Postoperatively, 18 patients (38%) stayed in the intensive care unit for a median of 15 (1-140) days. Thirty-day and in-hospital mortality was 6%. Pathologic response to induction treatment was complete (n = 18) or near complete (n = 6) in 24 patients (50%). After a median follow-up of 26 (0-151) months, 24 patients are alive without recurrence. Overall 5-year survival was 61%. Response to induction therapy (complete/near complete versus other, p = 0.012), resection margin (R0 versus R1/R2, p = 0.009), and length of intensive care unit stay (p = 0.003) were significant prognostic factors in univariate analysis. Response to induction was maintained as prognostic factor in multivariable analysis (p = 0.048).
  
  
  CONCLUSIONS
  En bloc resection of the lung, chest wall, and spine for non-small-cell lung cancer invading the pulmonary sulcus and spine is feasible in experienced centers with excellent long-term outcome after careful patient selection. Response to induction was an independent significant prognostic factor.
authors.affiliation: Divisions of *Thoracic Surgery, †Orthopedic Surgery, ‡Medical Oncology, §Radiation Oncology, and ‖Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Collaud
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Pierre
authors.forename: Gail E
authors.initials: GE
authors.lastname: Darling
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.forename: Yoga R
authors.initials: YR
authors.lastname: Rampersaud
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lewis
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.forename: John
authors.initials: J
authors.lastname: Cho
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Ming Sound
authors.initials: MS
authors.lastname: Tsao
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010178:Pancoast Syndrome / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D015996:Survival Rate