title: Surgical approach in T4N0M0 (vertebral involvement) lung cancer.
abstract: Approximately 5% of the cancers involve the chest wall and spine by direct extension and remain localized at the time of diagnosis. T4 lesions invading the vertebra are considered inoperable. We reviewed a new evolution in the surgical treatment of lung cancer involving the vertebra (T4N0M0) and report preliminary results of our approach. Four patients with T4N0M0 (vertebral involvement) lung cancer underwent en bloc surgical resection of tumor between 1998 and 2002. Posterior stabilization, hemilaminectomy, and osteotomy of the involved vertebral bodies below the corresponding pedicle were performed in the prone position and then, in the lateral position, en bloc resection was completed along with the lung resection (large wedge resection or lobectomy) and involved vertebral bodies. There was no immediate postoperative mortality. Three patients died during the follow-up period at the 6th, 8th, and 14th postoperative months with a postoperative recognized metastasis. The fourth patient was in follow-up at 20 months. Although T4N0M0 (vertebral involvement) lung cancers are considered inoperable, lung resection with hemivertebrectomy of the involved vertebra after neoadjuvant chemotherapy and radiotherapy is an alternative treatment in this type of lung cancer. Staging should be made meticulously for the expected surveillance.
authors: Department of Orthopedic Surgery, Faculty of Medicine, Uludag University, 16059, Görükle, Bursa, Turkey. rezocagatay@hotmail.com.
authors: Ufuk
authors: U
authors: Aydinli
authors: Department of Thorax Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors: Cengiz
authors: C
authors: Gebitekin
authors: Department of Thorax Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors: Sami
authors: S
authors: Bayram
authors: Department of Orthopedic Surgery, Faculty of Medicine, Uludag University, 16059, Görükle, Bursa, Turkey.
authors: Cagatay
authors: C
authors: Ozturk
authors: Department of Orthopedic Surgery, Faculty of Medicine, Uludag University, 16059, Görükle, Bursa, Turkey.
authors: Salim
authors: S
authors: Ersozlu
keywords: Hemivertebrectomy; Lung cancer; Pulmonary resection; Vertebral involvement; Vertebral osteotomy