Surgical experience in treating T4 lung cancer

Its resectability, morbidity, mortality and prognosis

Chung Ping Hsu, Nan Yung Hsu, Chih Yi Chen

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Extensive experience in the treatment of locally advanced lung cancers is rare. The aim of this study is to show the rationality and effectiveness of an aggressive surgical approach in T4 lung cancers. Between 1984 and 1994, 111 consecutive cases of T4 lung cancers mere operated on. The patients included 91 males and 20 females, with mean ages of 61.8 years and 55.3 years, respectively. The cell types included 57 squamous cell carcinomas, 42 adenocarcinomas, and 12 miscellaneous malignancies. Fifty-three (47.7%) procedures were non-resectional. The remaining 58 (52.3%) procedures had various extents of pulmonary resection. These surgical procedures included 24 (21.6%) pulmonary resections with gross residual tumour (R2), nine (8.1%) pulmonary resections with microscopic residual tumour (R1), and 25 (22.5%) curative pulmonary resections without residual tumour (RO). Post-operative adjuvant therapy included radiotherapy (≥ 3000 rads) in 53 patients (47.7%), and cisplatin-based chemotherapy in 15 patients (13.5%). The overall median survival time of these 111 patients was 9.1 months. The overall cumulative survival rates at 1, 2, 3 and 5 years were 38.0%, 20.4%, 15.3%, and 5.5%, respectively. There were 24 (21.6%) complications and eight (7.2%) hospital mortalities. Most of the pleural seedings were caused by adenocarcinomas, while most of the curatively resected tumours mere squamous cell carcinomas. Our data demonstrate that: (1) Almost a quarter (22.5%) of T4 lung cancers could be curatively resected, and the cumulative 5-year survival rate was 23.4%; (2) squamous cell carcinoma had a higher curative resection rate (P = 0.0381), while adenocarcinoma showed higher possibility of pleural seeding (P = 0.0000); (3) the prognosis of T4 lung cancers did not relate to their nodal status (P = 0.7978), and cell type (P = 0.4169); (4) complete surgical resection provided the best rates for long-term survival (P = 0.0263); (5) the complication rate was higher in the resectional group (P = 0.0221); (6) post-operative irradiation did not lengthen survival times (P = 0.1720); and (7) postoperative chemotherapy did not improve survival (P = 0.1577). We conclude that surgery for T4 lung cancers should only be performed in highly selected patients due to their poor prognosis, and the associated high complication and mortality rates.

Original languageEnglish
Pages (from-to)171-176
Number of pages6
JournalEuropean Journal of Surgical Oncology
Volume22
Issue number2
DOIs
Publication statusPublished - 1996
Externally publishedYes

Fingerprint

Lung Neoplasms
Morbidity
Mortality
Residual Neoplasm
Squamous Cell Carcinoma
Lung
Adenocarcinoma
Survival
Survival Rate
Drug Therapy
Hospital Mortality
Cisplatin
Neoplasms
Radiotherapy
Therapeutics

Keywords

  • Lung cancer
  • Surgery
  • T4 stage

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Surgical experience in treating T4 lung cancer : Its resectability, morbidity, mortality and prognosis. / Hsu, Chung Ping; Hsu, Nan Yung; Chen, Chih Yi.

In: European Journal of Surgical Oncology, Vol. 22, No. 2, 1996, p. 171-176.

Research output: Contribution to journalArticle

Hsu, Chung Ping ; Hsu, Nan Yung ; Chen, Chih Yi. / Surgical experience in treating T4 lung cancer : Its resectability, morbidity, mortality and prognosis. In: European Journal of Surgical Oncology. 1996 ; Vol. 22, No. 2. pp. 171-176.
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abstract = "Extensive experience in the treatment of locally advanced lung cancers is rare. The aim of this study is to show the rationality and effectiveness of an aggressive surgical approach in T4 lung cancers. Between 1984 and 1994, 111 consecutive cases of T4 lung cancers mere operated on. The patients included 91 males and 20 females, with mean ages of 61.8 years and 55.3 years, respectively. The cell types included 57 squamous cell carcinomas, 42 adenocarcinomas, and 12 miscellaneous malignancies. Fifty-three (47.7{\%}) procedures were non-resectional. The remaining 58 (52.3{\%}) procedures had various extents of pulmonary resection. These surgical procedures included 24 (21.6{\%}) pulmonary resections with gross residual tumour (R2), nine (8.1{\%}) pulmonary resections with microscopic residual tumour (R1), and 25 (22.5{\%}) curative pulmonary resections without residual tumour (RO). Post-operative adjuvant therapy included radiotherapy (≥ 3000 rads) in 53 patients (47.7{\%}), and cisplatin-based chemotherapy in 15 patients (13.5{\%}). The overall median survival time of these 111 patients was 9.1 months. The overall cumulative survival rates at 1, 2, 3 and 5 years were 38.0{\%}, 20.4{\%}, 15.3{\%}, and 5.5{\%}, respectively. There were 24 (21.6{\%}) complications and eight (7.2{\%}) hospital mortalities. Most of the pleural seedings were caused by adenocarcinomas, while most of the curatively resected tumours mere squamous cell carcinomas. Our data demonstrate that: (1) Almost a quarter (22.5{\%}) of T4 lung cancers could be curatively resected, and the cumulative 5-year survival rate was 23.4{\%}; (2) squamous cell carcinoma had a higher curative resection rate (P = 0.0381), while adenocarcinoma showed higher possibility of pleural seeding (P = 0.0000); (3) the prognosis of T4 lung cancers did not relate to their nodal status (P = 0.7978), and cell type (P = 0.4169); (4) complete surgical resection provided the best rates for long-term survival (P = 0.0263); (5) the complication rate was higher in the resectional group (P = 0.0221); (6) post-operative irradiation did not lengthen survival times (P = 0.1720); and (7) postoperative chemotherapy did not improve survival (P = 0.1577). We conclude that surgery for T4 lung cancers should only be performed in highly selected patients due to their poor prognosis, and the associated high complication and mortality rates.",
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