Pancoast Tumour with Spine Resection - Case Report (original) (raw)
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Journal of Neurosurgery: Spine, 1999
Object. Traditionally, superior sulcus tumors of the lung that involve the chest wall and spinal column have been considered to be unresectable, and historically, patients harboring these tumors have been treated with local radiation therapy with, at best, modest results. The value of gross-total resection remains unclear in this patient population; however, with the recent advances in surgical technique and spinal instrumentation, procedures involving more radical removal of such tumors are now possible. At The University of Texas M. D. Anderson Cancer Center, the authors have developed a new technique for resecting superior sulcus tumors that invade the chest wall and spinal column. They present a technical description of this procedure and results in nine patients in whom stage IIIb superior sulcus tumors extensively invaded the vertebral column. Methods. These patients underwent gross-total tumor resection via a combined approach that included posterolateral thoracotomy, apical ...
Asian spine journal, 2016
Monocentric prospective study. To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors. In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for "en-bloc" resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach. We included all patients who underwent posterior en-bloc resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation. Five patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46-61 years). The tumor involved 2 adjacent levels in ...
Asian Spine Journal
Study Design: Retrospective cohort study.Purpose: This study aimed to evaluate the outcomes of patients who had T4 Pancoast tumors invading the spine and underwent en bloc resection and spinal stabilization through a single-stage posterior approach.Overview of Literature: Surgical resection for Pancoast tumors affecting the spine has been successfully performed in two stages involving spinal reconstruction and tumor resection. However, reports have rarely presented the results of en bloc resection combined with spinal stabilization for T4 Pancoast tumors invading the spine through a single-stage posterior approach.Methods: Patients who had T4N0M0 Pancoast tumors invading the spine and underwent a single-stage posterior approach were retrospectively recruited. The following data were obtained and examined: demographics, tumor histology, preoperative and postoperative therapy, complications, spinal reconstruction technique, tumor resection extent, survival time, and disease recurrence...
Surgical treatment of Pancoast tumours
European Journal of Cardio-Thoracic Surgery, 2004
Due to its localisation in the apex of the lung with invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, a superior sulcus tumour causes characteristic symptoms, like arm or shoulder pain or Horner's syndrome. If rib invasion is the only feature, lysis of the rib must be evident on the chest radiograph; otherwise the tumour cannot be defined as a Pancoast tumour. It is important to adequately stage the tumour, because staging significantly influences survival. Survival is better for T3 than T4 tumours and mediastinal lymph node involvement has been found to be a negative prognostic factor. Also Horner's syndrome and incompleteness of resection worsen survival. The management of superior sulcus tumours has evolved over the past 50 years. Before 1950 it was considered to be inoperable and uniformly fatal. Shaw and Paulson introduced combined modality treatment and for many years, this combination of radiotherapy and surgery was the treatment of choice with a mean 5-year survival of approximately 30%. Postoperative radiotherapy or brachytherapy does not improve survival in patients with complete or incomplete resection. The tumour can be resected through the classic posterior Shaw -Paulson approach or the newer anterior transcervical approach, introduced by Dartevelle. This method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels. Regarding the extent of pulmonary resection, en bloc resection of the involved ribs with a lobectomy is recommended. Recent multimodality studies, involving chemoradiotherapy and surgical resection, show promising results regarding completeness of resection, local recurrence and survival, provided that appropriate staging has been carried out. However, careful patient selection and adequate perioperative management with protection of the bronchial stump or anastomosis are important to achieve reasonable rates of morbidity and mortality. As brain metastases remain one of the most common forms of relapse, further studies are needed to examine the role of prophylactic cranial irradiation in patients with complete resection. Also the addition of other chemotherapy agents or biologic agents such as angiogenesis inhibitors or tyrosine kinase inhibitors gives a new perspective in the treatment of Pancoast tumours. q .net (J.M.M. van den Bosch).
Radical en bloc resection for lung cancer invading the spine
The Journal of Thoracic and Cardiovascular Surgery, 2002
Objective: We reviewed our 8-year experience with en bloc partial and total vertebrectomy for lung cancer invading the spine and report outcome and survival. Methods: Nineteen patients with lung cancers involving the spine underwent en bloc resection. Eleven received induction treatment (chemotherapy, n = 5; chemoradiotherapy, n = 4; and radiation, n = 2). Pneumonectomy was performed in 3 patients, lobectomy in 13 patients, and wedge resection in 3 patients. Hemivertebrectomy was performed in 15 patients, and total vertebrectomy was performed in 4 patients. The median number of resected vertebral bodies was 3 (range, 1-4). Tumor stage was IIIB in 14 patients, IIIA in 1 patient, and IIB in 4 patients (hemivertebrectomy is performed in the case of T3 disease to obtain free margins). Surgical nodal status was N0 in 13 patients, N1 in 3 patients, N2 in 1 patient, and N3 (supraclavicular) in 2 patients. Complete macroscopic and microscopic resection was achieved in 15 (79%) patients. Results: There was no immediate postoperative mortality. Morbidity was observed in 10 patients, including 4 (21%) complications related to the spinal surgery. The median hospital stay was 30 days. Seven patients were alive after a mean follow-up of 26 months (range, 7-74 months). The 1-and 5-year predicted survivals (updated) are 59% and 14%, respectively. Nine local recurrences were observed. Conclusions: En bloc resection of chest tumors with vertebrectomy is technically demanding, and postoperative morbidity should be critically addressed with this aggressive surgical intervention. However, an encouraging long-term survival observed in this series suggests that en bloc resection could be a valid option in selected patients with vertebral involvement of chest tumors. N on-small cell lung cancers invading the thoracic inlet can easily involve spinal structures because of their particular anatomic situation. For this reason, most of the tumors invading the spine are located in the superior sulcus, although vertebral extension can be observed in tumors more caudally situated. Initial local control as a result of the first treatment provides the only possibility for survival for patients with superior sulcus tumors. 1,2 The best local control for resectable tumors is obviously achieved by surgical intervention, provided the resection is complete and respectful of oncologic principles. 3 Since the first descrip-From the Thoracic Department, a Orthopaedic Department,
The Annals of Thoracic Surgery, 2016
Background. En bloc vertebral resection of locally invasive T4 lung cancers led to the development of a surgical sequence for resection; posterior stabilization, reposition, thoracotomy, lobectomy, vertebrectomy, and anterior spine stabilization in 1 procedure. This technique expanded indications for vertebrectomy to selected patients with sarcoma and metastatic disease. We review our experience to identify areas for clinical improvement. Methods. Operative case logs were cross-checked with billing data from 2003 to 2014 with Current Procedural Terminology (CPT, American Medical Association) codes for vertebrectomy. Thirty-two cases involving en bloc resection of malignancy invading at least 1 thoracic vertebra were selected. Outcomes data were analyzed using summary statistics. Results. Series includes 14 men and 18 women, median age 50 years. Twenty-five patients (78%) received preoperative chemoradiation. Nineteen total and 13 partial
En bloc resection of non-small-cell lung cancer invading the spine☆
European Journal of Cardio-Thoracic Surgery, 2011
Objective: To describe our surgical en bloc approach and to assess the outcome and survival of non-small-cell lung cancer (NSCLC) invading the spine. Methods: We retrospectively reviewed our prospective database of all patients, who underwent lung resection with en bloc hemivertebrectomy or total vertebrectomy for NSCLC between January 2003 and December 2008 in an individualized multimodality treatment concept. Survival was estimated by the Kaplan-Meier method. Log-rank analyses were used to compare groups. Results: Twenty-eight patients (age 58.9 AE 12.9 years) were diagnosed with NSCLC invading the spine at a single center. Eight of those patients were inoperable. Twenty patients proceeded to surgery with en bloc hemivertebrectomy (n = 16) or total vertebrectomy (n = 4). Six patients had induction chemotherapy (30%). Complete resection could be achieved in 16 patients (80%). Morbidity was observed in eight patients (40%); no mortality occurred. Adjuvant radiation (n = 14) or chemoradiation (n = 6) was administered with 66 Gy. The mean survival and 5-year survival for patients, who underwent surgery (n = 20), were 46.0 months and 47%, respectively. Inoperable patients had poorer survival (14.0 months; p = 0.004). Sublobar resections (p = 0.002) and incomplete resections (p = 0.02) were associated with inferior survival. Adjuvant chemoradiation (p = 0.088), hemivertebrectomy (p = 0.062), and age < 70 years (p = 0.076) trended toward prolonged survival. Conclusions: Multimodality treatment including en bloc lung resections with hemivertebrectomy or total vertebrectomy offer promising long-term survival in highly selected patients with NSCLC invading the spine. These extended resections can be performed with acceptable morbidity and mortality in specialized centers. Patients aged ! 70 years should be selected very carefully for radical resection. Sublobar resections should be avoided.
En bloc vertebra resections and lung cancer
Shanghai Chest
Non-small cell lung cancer (NSCLC) invading the chest wall and vertebral bodies account for less than 5% of newly diagnosed patients, and their surgical management still represents, despite recent advances in material research, multimodality therapy and surgical techniques, a clinical unmet issue. They usually occur as direct unilateral invasion involving mostly the antero-lateral paths of the vertebral bodies, and costovertebral groove. Computed tomography and magnetic resonance imaging studies are pivotal to assess operability and guide the type of surgical management which must always aim the en bloc resection of the tumor with clean surgical margins and spine reconstruction. While there is no need of vertebral body resection for NSCLC invading the ipsilateral ribs and vertebral transverse processes, hemi-vertebrectomy or total vertebrectomy is required when tumors invade the ipsilateral side or more than 50 percent of the vertebral body, respectively. Different approaches (anterior, posterior or their combination, etc.) and different types of vertebral resection and stabilization have been described. Preoperatively, one may consider embolization of the endovascular intercostal-somatic arteries feeding the tumor one day before the operation to mitigate intraoperative blood losses. Despite high morbidity and tumor recurrence rates, 5-year survival rates of 60% have been recently reported for NSCLC invading the vertebral body. As a consequence, surgery shall be considered in well-selected NSCLC patients and in large-volume thoracic and spine surgical.