Volkan KARAÇAM, Sami KARAPOLAT, İlhan ÖZTOP, Ahmet ÖNEN, Ünal AÇIKEL, Kemal YÜCESOY, Banu GÖKÇEN, Murat Gün EYÜBOĞLU, Ayşenur DEMİRAL, Aydın ŞANLI

Göğüs duvarı (T3) ve vertebra (T4) tutulumu olan küçük hücreli dışı akciğer kanseri olgularında cerrahi tedavi

Küçük hücreli dışı akciğer kanseri (KHDAK)’nin göğüs duvarı (T3) ve vertebra (T4) tutulumuna, cerrahi uygulanan hastalarda %3-8 oranında rastlanmaktadır. Gerek T3 gerekse T4 tümörlerde sağkalımı etkileyen en önemli faktörler, lenf nodu tutulumu olmaması ve komplet rezeksiyon uygulanmasıdır. Ocak 2004-Temmuz 2006 tarihleri arasında 162 olgu anabilim dalımızda KHDAK nedeniyle ameliyat edildi. Bu olgular retrospektif olarak incelenerek göğüs duvarı invazyonu olan 12 (%7.4), vertebra invazyonu olan 4 (%2.5) olgu saptandı. N0 lenf nodu olan T3 ve T4 tümörler ameliyatta alındı. Göğüs duvarı invazyonlu üç olguya en blok rezeksiyon, dokuz olguya ekstraplevral rezeksiyon yapıldı. Vertebra invazyonlu tüm olgulara en blok rezeksiyon ve vertebral enstrümantasyon, uygulandı. Bir olguya posterior yaklaşımla hemikorpektomi ve enstrümentasyonu takiben posterolateral torakotomiyle sol alt lobektomi uygulanırken, iki olguya posterolateral torakotomi ile vertebral hemikorpektomi ve enstrümantasyon ardından akciğer rezeksiyonu uygulandı. Bir olguya ise parsiyel vertebral korpektomi sonrasında enstrümantasyon, uygulanmadan göğüs duvarı rezeksiyonu uygulandı. Sonuçta, lenf nodu tutulumu olmayan T3 ve T4 KHDAK’lı olgularda komplet rezeksiyon ve preoperatif ve/veya postoperatif radyoterapi veya kemoradyoterapi iyi sonuçlar sağlamaktadır.

Surgical treatment in non-small cell lung cancer invading to the chest wall (T3) and vertebra (T4)

The involvement of the chest wall (T3) or the vertebra (T4) in non-small cell lung cancer is seen at a ratio between 3–8 % in patient’s undergone surgery. The most important factors affecting the survival in both T3 and T4 tumors are the absence of lymph node invasion and a complete resection application. Amount of 162 cases were subjected to operation due to on-small cell lung cancer between January 2004 - July 2006. Examined retrospectively, these cases were determined to be chest wall invasion in 12 cases (7.4%) and vertebra invasion in 4 cases (2.5%). T3 and T4 tumors with N0 lymph nodules were removed during operation. En block resection was applied to 3 cases with chest wall invasion and extrapleural resection was applied to 9 cases. All the cases with vertebra invasion were subjected to en block resection and instrumentation. While left lower lobectomy with posterolateral thoracotomy was applied to one case following hemicorpectomy and instrumentation under posterior approach, lung resection following hemicorpectomy and instrumentation with a posterolateral thoracotomy approach were applied to two cases. However, chest wall resection without instrumentation was applied to one case following partial corpectomy. The patients underwent a complete resection and having no lymph node invasion show a long lasting survival with radiotherapy or chemoradiotherapy preoperatively and / or postoperatively.

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