title: Left atrial resection for T4 lung cancer without cardiopulmonary bypass: technical aspects and outcomes.
abstract: BACKGROUND
  Extended resection for lung cancer may improve survival of selected patients. Left-atrial resection is infrequently performed and surgical techniques are rarely reported; thus, oncologic results and survival rates remain uncertain. Our study describes surgical techniques, postoperative outcomes, and oncologic results of patients who received a combined multimodality treatment.
  
  
  METHODS
  Between October 2004 and March 2012 in our institution, 19 patients underwent extended lung resection involving the left atrium without cardiopulmonary bypass. We reviewed perioperative treatments, surgical procedures, and postoperative morbidity, mortality, and long-term survival rates.
  
  
  RESULTS
  Sixteen patients (68.4%) underwent neoadjuvant treatment including chemotherapy or radiotherapy. Eighteen pneumonectomies (94.7%) were performed, of which 12 (63.1%) were right sided. Dissection of the interatrial septum was complete in 4 patients (33.3%). Complete resection was achieved in 17 patients (89.4%) and 2 other patients (10.5%) were considered R1. The T-status was pT4 in all patients. Overall postoperative morbidity was 52.6%. The 30-day mortality rate was 10.5% and the 90-day mortality rate was 15.7%. Fifteen patients (93.7%) underwent adjuvant treatment. The mean follow-up time was 32.5 months. The 5-year probability of survival was 43.7%. Three patients (15.7%) were alive at greater than 6 years postsurgery.
  
  
  CONCLUSIONS
  Extended lung surgery with partial resection of the left atrium is a feasible procedure with acceptable morbidity. An interatrial septum dissection, by increasing the length of the atrial cuff, allows complete resection. Long-term survival can be achieved in highly selected patients who have undergone multimodal therapy.
authors.affiliation: Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France; Clermont Université, Univ Clermont 1, Faculté de Médecine, Laboratoire d'anatomie, Clermont-Ferrand, France. Electronic address: geraud.galvaing@cjp.fr.
authors.forename: Geraud
authors.initials: G
authors.lastname: Galvaing
authors.affiliation: Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France.
authors.forename: Marie M
authors.initials: MM
authors.lastname: Tardy
authors.affiliation: CHU Clermont-Ferrand, service de radiologie, Hôpital G. Montpied, Clermont-Ferrand, France; Centre National de Recherche Scientifique, Institut des Sciences de l'Image pour les Techniques interventionnelles, Unité Mixte de Recherche 6284.
authors.forename: Lucie
authors.initials: L
authors.lastname: Cassagnes
authors.affiliation: Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France.
authors.forename: Valinkini
authors.initials: V
authors.lastname: Da Costa
authors.affiliation: Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Chadeyras
authors.affiliation: Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France.
authors.forename: Adel
authors.initials: A
authors.lastname: Naamee
authors.affiliation: Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bailly
authors.affiliation: Université Orléans, Laboratoire Complexité Innovation et Activités Motrices et Sportives, Equipe d'Accueil 452, Université Paris-Sud; Orléans, France; Unité de Formation et de Recherche Sciences et Techniques des Activités Physiques et Sportives, 2 allée du Château, Orléans, France.
authors.forename: Edith
authors.initials: E
authors.lastname: Filaire
authors.affiliation: CHU Clermont-Ferrand, The biostatistic division, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France; Clermont Université, Univ Clermont 1, Faculté de Médecine, Laboratoire d'anatomie, Clermont-Ferrand, France; Institut Nationale de Recherche Agronomique, Unité Mixte de Recherche 1019, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Filaire
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis