Surgery on Extracorporeal Circulation in Early and Advanced Non-Small Cell Lung Cancer

Abstract

Background Locally advanced (T4) non-small cell lung cancer (NSCLC) is principally amenable to surgery. For radical resection of cardiovascular structures, extracorporeal circulation (ECC) may be required. Tumor dissemination is a concern in this situation. In this study, we evaluate the long-term results of T4 NSCLC surgery with ECC and compare them with combined cardiopulmonary surgery for early-stage NSCLC and heart disease.

Methods We retrospectively analyzed 16 patients undergoing surgery on ECC over a 13-year period. Eight patients suffered from T4 NSCLC (group A), and another eight patients suffered from coincidental T1–T2 NSCLC and heart disease (group B).

Results In group A, five patients received neoadjuvant radiochemotherapy. Complete resection was achieved in all patients. Thirty-day mortality was one patient (12.5%) in each group. Six patients died from recurrent cancer with a median survival of 13.6 months in group A. Prognosis in patients with direct tumor invasion of the aortopulmonary window was a lot worse compared to those with atrial infiltration. One T4 patient who had only received surgery survived for 155 months without relapse. In group B, no NSCLC relapse occurred, and median survival was 21.6 months. All but one death in group B occurred due to cardiovascular incidents.

Conclusions Surgery on ECC for T4 NSCLC gives satisfactory results. The site of infiltration appears to be most important for local tumor relapse. Long-term survival is possible in some cases. Simultaneous cardiac and pulmonary surgery resulted in good early and midterm outcomes without surgery-induced tumor propagation.

Keywords

lung cancer - NSCLC - cardiopulmonary surgery - extracorporeal circulation - cardiopulmonary bypass ECC

• References

• 1 Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60 (5) 277-300
• 2 Aupérin A, Le Péchoux C, Pignon JP , et al; Meta-Analysis of Cisplatin/carboplatin based Concomitant Chemotherapy in non-small cell Lung Cancer (MAC3-LC) Group. Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Ann Oncol 2006; 17 (3) 473-483
• 3 Jett JR, Scott WJ, Rivera MP, Sause WT. American College of Chest Physicians. Guidelines on treatment of stage IIIB non-small cell lung cancer. Chest 2003; 123 (1, Suppl) 221S-225S
• 4 Friedel G, Budach W, Dippon J , et al. Phase II trial of a trimodality regimen for stage III non-small-cell lung cancer using chemotherapy as induction treatment with concurrent hyperfractionated chemoradiation with carboplatin and paclitaxel followed by subsequent resection: a single-center study. J Clin Oncol 2010; 28 (6) 942-948
• 5 Akchurin RS, Davidov MI, Partigulov SA , et al. Cardiopulmonary bypass and cell-saver technique in combined oncologic and cardiovascular surgery. Artif Organs 1997; 21 (7) 763-765
• 6 Yildizeli B, Dartevelle PG, Fadel E, Mussot S, Chapelier A. 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 (4) 1065-1075 , discussion 1074–1075
• 7 Wang T, Nelson RA, Bogardus A, Grannis Jr FW. Five-year lung cancer survival: which advanced stage nonsmall cell lung cancer patients attain long-term survival?. Cancer 2010; 116 (6) 1518-1525
• 8 Riquet M, Grand B, Arame A , et al. Lung cancer invading the pericardium: quantum of lymph nodes. Ann Thorac Surg 2010; 90 (6) 1773-1777
• 9 Muralidaran A, Detterbeck FC, Boffa DJ, Wang Z, Kim AW. Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass: a systematic review. J Thorac Cardiovasc Surg 2011; 142 (5) 1137-1142
• 10 Miller DL, Orszulak TA, Pairolero PC, Trastek VF, Schaff HV. Combined operation for lung cancer and cardiac disease. Ann Thorac Surg 1994; 58 (4) 989-993 , discussion 993–994
• 11 Rao V, Todd TR, Weisel RD , et al. Results of combined pulmonary resection and cardiac operation. Ann Thorac Surg 1996; 62 (2) 342-346 , discussion 346–347
• 12 Suzuki K, Asamura H, Watanabe S, Tsuchiya R. Combined resection of superior vena cava for lung carcinoma: prognostic significance of patterns of superior vena cava invasion. Ann Thorac Surg 2004; 78 (4) 1184-1189 , discussion 1184–1189
• 13 Spaggiari L, Thomas P, Magdeleinat P , et al. Superior vena cava resection with prosthetic replacement for non-small cell lung cancer: long-term results of a multicentric study. Eur J Cardiothorac Surg 2002; 21 (6) 1080-1086
• 14 Ratto GB, Costa R, Vassallo G, Alloisio A, Maineri P, Bruzzi P. Twelve-year experience with left atrial resection in the treatment of non-small cell lung cancer. Ann Thorac Surg 2004; 78 (1) 234-237
• 15 Venuta F, Ciccone AM, Anile M , et al. Reconstruction of the pulmonary artery for lung cancer: long-term results. J Thorac Cardiovasc Surg 2009; 138 (5) 1185-1191
• 16 de Perrot M, Fadel E, Mussot S, de Palma A, Chapelier A, Dartevelle P. Resection of locally advanced (T4) non-small cell lung cancer with cardiopulmonary bypass. Ann Thorac Surg 2005; 79 (5) 1691-1696 , discussion 1697
• 17 Hasegawa S, Otake Y, Bando T, Cho H, Inui K, Wada H. Pulmonary dissemination of tumor cells after extended resection of thyroid carcinoma with cardiopulmonary bypass. J Thorac Cardiovasc Surg 2002; 124 (3) 635-636
• 18 Ohta M, Hirabayasi H, Shiono H , et al. Surgical resection for lung cancer with infiltration of the thoracic aorta. J Thorac Cardiovasc Surg 2005; 129 (4) 804-808
• 19 Mayer F, Aebert H, Rudert M , et al. Primary malignant sarcomas of the heart and great vessels in adult patients—a single-center experience. Oncologist 2007; 12 (9) 1134-1142
• 20 Hendrix H, Schmitt J, Aebert H. [Ex situ sleeve resection and autotransplantation of the left lower pulmonary lobe after extended pneumonectomy]. Chirurg 2000; 71 (7) 820-823