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  MTE 15 - Management of Major Airway and Vascular Obstruction (Ticketed Session) (ID 67)

  • Event: WCLC 2015
  • Type: Meet the Expert (Ticketed Session)
  • Track: Treatment of Locoregional Disease – NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/08/2015, 07:00 - 08:00, 109

  • 14285

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    MTE15.01 - Management of Major Airway and Vascular Obstruction (ID 2000)

    07:00 - 08:00  |  Author(s): G. Stamatis
    • Abstract

    Abstract:
    Lung cancer represents the major causes of cancer death in the industrialized countries. Non-small cell lung cancer (NSCLC) accounts for nearly 80% of all lung cancer cases. While in the early stages I and II surgery has been accepted as the major curative therapy, most of patients with NSCLC and major airway and vascular obstruction have an IIIB disease and rarely can be cured by local treatment modalities like surgery or radiotherapy alone. T4 tumors may include the mediastinal organs such as the vena cava, pulmonary artery, thoracic aorta, left atrium, carina and trachea. However the extend of the disease is usually made by radiological methods as computed tomography (CT), magnetic resonance imaging (MRT) or fusioned positron emission tomography and CT-scan (PET-CT) and the correlation between radiologic and pathologic findings is very low. Combined resection of the lung and major vessels or central airways for lung cancer remains challenging in terms of technical aspects and prognosis, because the local advanced disease comprises different subgroups with distinguishable clinical problems and necessary treatment decisions. In the surgical treatment of lung cancer invading the superior vena cava (SVC), the pattern of invasion was considered to be a significant prognostic factor. Patients who underwent partial SVC resection had a significantly higher probability of survival and there was a trend towards later recurrence in patients who had induction treatment. Also survival of patients with N2 disease was significantly worse than those with localized N0/N1 nodal status (1). For combined resection of thoracic aorta and primary lung cancer only studies with small number of cases are reported. The most patients received an adventitia resection or a patch graft repair of the defect in the aortic wall. For a smaller group total replacement of the descending aorta with an artificial vessel was reported, recent report indicated the placement of endoluminal prosthesis 1-3 weeks before surgery. Operative deaths occur in 0-24%, the 5 year survival ranged between 17% and 50%. Survival was only depended on mediastinal nodal involvement (2). Direct invasion of the left atrium (LA) has generally a significantly worse prognosis than patients with great vessels invasion. Patients who undergo LA resection have higher mortality and morbidity rates compared with those who had pneumonectomy alone. Median survival rate is 10 months, the 5-yearsurvival 14-16%. Palliative incomplete resection of T4 disease has not shown any survival benefit (3). Patients with localized invasion of the carina or/and distal trachea may be able to be completely resected despite their T4 classification. Extraluminal extension of the tumor found in CT-scan was associated with unresectability. In general, patients benefit from surgery, when a radical resection and systematic lymph node dissection can be achieved with low morbidity and mortality (4). For inoperable patients, palliative treatment with laser desobliteration, stent implantation or photodynamic therapy can be added to the standard chemoradiotherapy. Surgery in the treatment of lung cancer invading the great vessels, LA and major airways may improve survival only in selected patients. Induction treatment and new drugs may increase the number of potential candidates for surgery and improve survival. Preoperative every possible effort should be made to achieve an adequate evaluation of N-status. Complete resection is important and patient’s functional status must be compatible with the extent of resection and reconstruction. Literature Suzuki K, Asamura H, Watanabe S et al. Combined resection of superior vena cava for lung carcinoma: prognostic significance of patterns of superior vena cava invasion. Ann Thorac Surg 2004; 78:1184-9 Shiraishi T, Shirakusa T, Miyoshi T, et al. Extended resection of T4 lung cancer with invasion of the aorta; is it justified? Thorac Cardiovasc Surg 2005,53:375-9 Fukuse T, Wada H, Hitomi S. Extended operation for non-small cell lung cancer invading great vessels and left atrium. Eur J Cardiothorac Surg 1997; 11:664-9 Yildizeli B, Dartevelle PG, Fadel E, et al. Results of primary surgery with T4 non-small cell lung cancer during a 25-year period in a single center: the benefit is worth the risk. Ann Thorac Surg 2008, 86:1065-75