title: Outcomes After Resection of T4 Non-Small Cell Lung Cancer Using Cardiopulmonary Bypass.
abstract: BACKGROUND
  Complete, en bloc resection offers the greatest chance of long-term survival in T4 non-small cell lung cancer (NSCLC). The use of cardiopulmonary bypass (CPB) to achieve an en bloc resection is controversial because of potentially increased bleeding, lung dysfunction, and tumor dissemination. We reviewed our institutional experience to assess CPB's effect on survival.
  
  
  METHODS
  All patients who underwent resection for T4 NSCLC at our institution between 1980 and 2013 were retrospectively reviewed and stratified according to whether they did (CPB group, n = 20) or did not (No CPB group, n = 355) undergo CPB. Primary outcomes of interest were overall and disease-free survival and perioperative complications.
  
  
  RESULTS
  Baseline characteristics and medical therapy were similar between the groups. Median overall survival for all patients was 31 months, with 1-, 3-, 5-, and 10-year survival of 73%, 47%, 40%, and 26%, respectively. Median disease-free survival for all patients was 19 months, with 1-, 3-, 5-, and 10-year disease-free survival of 61%, 40%, 33%, and 21%, respectively. No difference was found in overall or disease-free survival at 1, 3, 5, and 10 years between the No CPB and CPB groups (p = 0.89 and p = 0.88). In addition, no differences were found in the rates of major perioperative complications.
  
  
  CONCLUSIONS
  The use of CPB allows for complete, en bloc resection in otherwise inoperable patients with T4 NSCLC and offers similar overall and disease-free survival to patients resected without CPB. All thoracic surgeons who manage T4 NSCLC should consider the use of CPB if it is necessary to achieve a complete, en bloc resection.
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France.
authors.forename: Nathaniel B
authors.initials: NB
authors.lastname: Langer
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France.
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fabre
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France.
authors.forename: James
authors.initials: J
authors.lastname: Lawton
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France.
authors.forename: Sacha
authors.initials: S
authors.lastname: Mussot
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dartevelle
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France. Electronic address: e.fadel@ccml.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome