Geraud Galvaing1, Marie M Tardy2, Lucie Cassagnes3, Valinkini Da Costa2, Jean Baptiste Chadeyras2, Adel Naamee2, Patrick Bailly2, Edith Filaire4, Bruno Pereira5, Marc Filaire6. 1. Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France; Clermont Université, Univ Clermont 1, Faculté de Médecine, Laboratoire d'anatomie, Clermont-Ferrand, France. Electronic address: geraud.galvaing@cjp.fr. 2. Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France. 3. CHU Clermont-Ferrand, service de radiologie, Hôpital G. Montpied, Clermont-Ferrand, France; Centre National de Recherche Scientifique, Institut des Sciences de l'Image pour les Techniques interventionnelles, Unité Mixte de Recherche 6284. 4. Université Orléans, Laboratoire Complexité Innovation et Activités Motrices et Sportives, Equipe d'Accueil 452, Université Paris-Sud; Orléans, France; Unité de Formation et de Recherche Sciences et Techniques des Activités Physiques et Sportives, 2 allée du Château, Orléans, France. 5. CHU Clermont-Ferrand, The biostatistic division, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. 6. Centre Jean Perrin, Service de chirurgie thoracique, Université Clermont 1, Clermont-Ferrand, France; Clermont Université, Univ Clermont 1, Faculté de Médecine, Laboratoire d'anatomie, Clermont-Ferrand, France; Institut Nationale de Recherche Agronomique, Unité Mixte de Recherche 1019, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France.
Abstract
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.
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.
Authors: Shadi Hamouri; Nasr Alrabadi; Sebawe Syaj; Hassan Abushukair; Obada Ababneh; Leen Al-Kraimeen; Majd Al-Sous; Erich Hecker Journal: Surg Today Date: 2022-01-09 Impact factor: 2.549