Lung adenocarcinoma with intraoperatively diagnosed pleural seeding: Is main tumor resection beneficial for prognosis?
Journal
Journal of Thoracic and Cardiovascular Surgery
Journal Volume
155
Journal Issue
3
Pages
1238-12490
Date Issued
2018
Author(s)
Abstract
Objective: To evaluate whether main tumor resection improves survival compared with pleural biopsy alone in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. Methods: Forty-three patients with lung adenocarcinoma with pleural seeding diagnosed unexpectedly during surgery performed between January 2006 and December 2014 were included in this retrospective study using a prospectively collected lung cancer database. Each surgeon decided whether to perform main tumor resection or pleural biopsy alone. Results: Main tumor and visible pleural nodule resection was performed in 30 patients (tumor resection group). The remaining 13 patients underwent pleural nodule biopsy alone (open-close group). The clinical T stage was higher in the open-close group than in the tumor resection group (P =.02). The tumor resection group had longer operative times compared with the open-close group (mean, 141.8 vs 80.3 minutes). There were no other statistically significant differences in perioperative parameters. The surgical method was the sole statistically significant prognostic factor. Patients in the tumor resection group had better progression-free survival (3-year survival: 44.5% vs 0%; P =.009) and overall survival (3-year survival: 82.9% vs 38.5%; P =.013) than did the open-close group. There was no significant survival difference between sublobar resection and lobectomy for the main tumor resection. Conclusions: Our study demonstrated improved progression-free and overall survival after main tumor and visible pleural nodule resection in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. Further randomized trials are needed to define the role of main tumor resection in these patients. ? 2017 The American Association for Thoracic Surgery
SDGs
Other Subjects
crizotinib; epidermal growth factor receptor kinase inhibitor; platinum derivative; protein tyrosine kinase inhibitor; adjuvant chemotherapy; adult; aged; Article; artificial ventilation; cancer prognosis; cancer radiotherapy; cancer staging; cancer surgery; clinical article; clinical effectiveness; clinical evaluation; controlled study; correlation analysis; disease course; distant metastasis; female; follow up; human; human tissue; incidental finding; intraoperative period; lobectomy; lung adenocarcinoma; lymph node dissection; male; malignant pleura effusion; mediastinum lymph node; operation duration; outcome assessment; overall survival; perioperative period; peroperative complication; pleura biopsy; pleura metastasis; postoperative hemorrhage; priority journal; progression free survival; retrospective study; segmentectomy; statistical analysis; thorax surgery; video assisted thoracoscopic surgery; vocal cord paralysis; wedge resection; adverse event; biopsy; clinical decision making; disease exacerbation; factual database; lung adenocarcinoma; lung resection; lung tumor; middle aged; mortality; pathology; peroperative care; pleura; predictive value; risk assessment; risk factor; time factor; tumor seeding; very elderly; Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Biopsy; Clinical Decision-Making; Databases, Factual; Disease Progression; Female; Humans; Intraoperative Care; Lung Neoplasms; Male; Middle Aged; Neoplasm Seeding; Pleura; Pneumonectomy; Predictive Value of Tests; Progression-Free Survival; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors
Publisher
Mosby Inc.
Type
journal article