Kardiyovasküler yapısal invazyonları olan ileri akciğer kanseri için genişletilmiş pnömonektomi

Amaç: Bu çalışmada kardiyovasküler yapısal rezeksiyon ile genişletilmiş pnömonektomi uygulanan hastalarda tümör evrelerine ilişkin belirleyici faktörler, mediastinal tutulumlar, perioperatif adjuvan terapiler ve cerrahi teknikler araştırıldı. Çalışma planı: PubMed, Google Scholar ve HighWire Press’te 2000-2016 yıl aralığı için kardiyovasküler yapısal rezeksiyonlar ile genişletilmiş pnömonektomiler için kapsamlı bir literatür derlemesi yapıldı. Çalışma popülasyonu, demografikler, klinik özellikler, akciğer kanseri türleri, patolojik evreler, nodal tutulum, pnömonektomi boyutu, kardiyovasküler yapısal rezeksiyonlar, kardiyopulmoner baypas kullanımı, rezeksiyonun tamlığı, ameliyat öncesi ve sonrası adjuvan terapiler, 1-5 yıllık sağkalım, medyan sağkalım süresi, komorbidite ve mortalite gibi ayrıntılarla ilgili veriler dikkatle çıkartıldı. Bulgular: Kardiyovasküler yapısal rezeksiyon ile genişletilmiş pnömonektomi uygulanan hastalar daha fazla skuamöz karsinomalar, N0 veya N1, T4, evre 3 ve sol atriyal invazyonlar ile karakterize idi. Radyoterapi veya kemoterapiye göre daha fazla hasta ameliyat sonrası radyokemoterapi aldı. Beş yıllık sağkalım oranı %30.5±11.5 ve medyan sağkalım süresi 23.0±10.7 ay idi. Düzey 1 sol atriyal, aortik adventisya ve parsiyel superior vena kava rezeksiyonları kardiyopulmoner baypas olmaksızın yapılabilir iken aort veya superior/inferior vena kava replasmanı ile düzey 2 ve 3 sol atriyal rezeksiyonları kardiyopulmoner baypas altında uygulanmalıdır. Sonuç: Kardiyopulmoner baypasın gelişimi akciğer kanserinin tam rezeksiyonunu kolaylaştırmakla beraber potansiyel metastaz ve nüks risklerine neden olmaktadır. Patolojik durum, cerrahi teknikler ve ameliyat öncesi ve sonrası adjuvan terapiler sağkalımı anlamlı şekilde etkilemektedir. Cerrahi endikasyonlar ve hastaların sağkalımı için negatif belirleyici risk faktörleri daha ileri değerlendirmeler gerektirmektedir.

Extended pneumonectomy for advanced lung cancer with cardiovascular structural invasions

Background: This study aims to investigate the predictive factors in relation to tumor stages, mediastinal involvements, perioperative adjuvant therapies and surgical techniques in advanced lung cancer patients who underwent extended pneumonectomy with cardiovascular structural resection.Methods: A comprehensive literature review was performed for extended pneumonectomies with cardiovascular structural resections in the PubMed, Google Scholar and HighWire Press for the year range 2000-2016. Data were carefully extracted regarding details such as the study population, demographics, clinical features, types of lung cancer, pathologic stages, nodal involvement, extent of pneumonectomy, cardiovascular structural resections, use of cardiopulmonary bypass, completeness of resection, pre- and postoperative adjuvant therapies, 1-5-year survival, median survival duration, comorbidity and mortality.Results: Patients undergoing extended pneumonectomy with cardiovascular structural resection were characterized more by squamous carcinomas, N0 or N1, T4, stage 3 and left atrial invasions. More patients received postoperative radiochemotherapy than radio-or chemotherapy. The five-year survival rate was 30.5±11.5% and the median survival duration was 23.0±10.7 months. Level 1 left atrial, aortic adventitial, and partial superior vena cava resections could be performed without cardiopulmonary bypass, while levels 2 and 3 left atrial resections with aorta or superior/inferior vena cava replacement should be performed under cardiopulmonary bypass.Conclusion: The advent of cardiopulmonary bypass facilitated complete resection of lung cancer, while leading to potential risks of metastasis and reoccurrence. Pathological status, surgical techniques and pre- and postoperative adjuvant therapies affect survival significantly. Surgical indications and negative predictive risk factors for patients’ survival warrant further evaluations.

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