1. Left Atrial Resection for T4 Lung Cancer Without Cardiopulmonary Bypass: Technical Aspects and Outcomes
- Author
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Valinkini Da Costa, Lucie Cassagnes, Jean Baptiste Chadeyras, Marie M. Tardy, Marc Filaire, Géraud Galvaing, Bruno Pereira, Patrick Bailly, Edith Filaire, Adel Naamee, Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), Complexité, Innovation, Activités Motrices et Sportives (CIAMS), Université Paris-Sud - Paris 11 (UP11)-Université d'Orléans (UO), Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), and CHU Clermont-Ferrand
- Subjects
Male ,Lung Neoplasms ,Databases, Factual ,SURGERY ,medicine.medical_treatment ,Kaplan-Meier Estimate ,GREAT-VESSELS ,030204 cardiovascular system & hematology ,law.invention ,Cohort Studies ,0302 clinical medicine ,law ,Carcinoma, Non-Small-Cell Lung ,Pneumonectomy ,Neoadjuvant therapy ,Cardiopulmonary Bypass ,EXTENDED PNEUMONECTOMY ,Mortality rate ,Multimodal therapy ,Chemoradiotherapy ,Middle Aged ,Prognosis ,Neoadjuvant Therapy ,3. Good health ,Dissection ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,[SCCO.PSYC]Cognitive science/Psychology ,SURVIVAL ,Female ,Cardiology and Cardiovascular Medicine ,Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Disease-Free Survival ,03 medical and health sciences ,MORBIDITY ,medicine ,Cardiopulmonary bypass ,Humans ,Neoplasm Invasiveness ,Heart Atria ,Cardiac Surgical Procedures ,Lung cancer ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,MORTALITY ,[SCCO.NEUR]Cognitive science/Neuroscience ,Perioperative ,medicine.disease ,Survival Analysis ,Surgery ,business ,Interatrial septum - Abstract
International audience; 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.
- Published
- 2014
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