Unexpected extensions of non-small-cell lung cancer diagnosed during surgery: revisiting exploratory thoracotomies and incomplete resections
OBJECTIVES Only patients with a complete resection of non-small-cell lung cancer (NSCLC) may expect long-term survival. Despite the recent progress in imaging and induction therapy, a thoracotomy may remain exploratory or with incomplete resection (R2). Our purpose was to revisit these situations. M...
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| Veröffentlicht in: | Interactive cardiovascular and thoracic surgery 2013-05, Vol.16 (5), p.667-672 |
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| creator | Foucault, Christophe Mordant, Pierre Grand, Bertrand Achour, Karima Arame, Alex Dujon, Antoine Le Pimpec Barthes, Françoise Riquet, Marc |
| description | OBJECTIVES
Only patients with a complete resection of non-small-cell lung cancer (NSCLC) may expect long-term survival. Despite the recent progress in imaging and induction therapy, a thoracotomy may remain exploratory or with incomplete resection (R2). Our purpose was to revisit these situations.
METHODS
A total of 5305 patients who underwent surgery for NSCLC between 1980 and 2009 were reviewed. We compared the epidemiology, pathology, causes and prognosis characteristics of exploratory thoracotomy (ET) and R2 resections.
RESULTS
ET and R2 resections were observed in 223 (4%) and 197 (4%) patients, respectively. The frequency of ET decreased with time, while the frequency of R2 resection remained almost stable. The indications for ET and R2 resections were not significantly different. In comparison with ET, R2 resections were characterized by a significantly higher frequency of induction therapy (22 vs 17%, P < 10−3), adenocarcinomas (49 vs 15%, P < 10−6), T1-T2 (53 vs 29%, P < 10−6) and N0-N1 extension (67 vs 42%, P = 10−6). R2 resections were also characterized by a higher rate of postoperative complications (19.1 vs 9.9%, P = 0.014), with no significant difference in postoperative mortality (6.9 vs 4.9%, P = non significant). R2 resections resulted in a higher 5-year survival compared with ET (11.1 vs 1.2%, P = 10−3). There was no long-term survivor after ET, except during the last decade.
CONCLUSIONS
ET and R2 remain unavoidable. In comparison with ET, R2 resection is associated with a higher rate of postoperative complications, but a higher long-term survival. |
| doi_str_mv | 10.1093/icvts/ivs512 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_TOX</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3630409</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/icvts/ivs512</oup_id><sourcerecordid>1338393813</sourcerecordid><originalsourceid>FETCH-LOGICAL-c416t-33caca49a89077cd89a651e41c45e0e4298d59153265f6dfdf946aeab19f05143</originalsourceid><addsrcrecordid>eNp9UbFuFDEQtRCIJAcdNXIHBUvs9XqzpkBCEYFIkdKQ2nLs2YuR11483lPuH_hofLlwgibVjGbevDd6j5A3nH3kTIlTbzcFT_0GJW-fkWMue9WodpDPD70SR-QE8SdjXDHBXpKjVohODKI_Jr9vItzPYAs4CvcFIvoUkaaRxhQbnEwIjYUQaFjimloTLWTqvFnHhPXELdnXOS55DXn7iWbYePRlN6u0IWVTUt7Sclc7m0qaPCA10VEfbZrmAAXqDVb9newr8mI0AeH1Y12Rm4uvP86_N1fX3y7Pv1w1tuN9aYSwxppOmUGxszPrBmV6yaHjtpPAoGvV4KTiUrS9HHs3ulF1vQFzy9XIJO_Einze887L7QTOQizZBD1nP5m81cl4_f8m-ju9ThstesG6avqKvH8kyOnXAlj05HFnk4mQFtRcVHeVGGpdkQ97qM0JMcN4kOFM7wLUDwHqfYAV_vbf1w7gv4lVwLs9IC3z01R_AEUyrDs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1338393813</pqid></control><display><type>article</type><title>Unexpected extensions of non-small-cell lung cancer diagnosed during surgery: revisiting exploratory thoracotomies and incomplete resections</title><source>Oxford Open</source><creator>Foucault, Christophe ; Mordant, Pierre ; Grand, Bertrand ; Achour, Karima ; Arame, Alex ; Dujon, Antoine ; Le Pimpec Barthes, Françoise ; Riquet, Marc</creator><creatorcontrib>Foucault, Christophe ; Mordant, Pierre ; Grand, Bertrand ; Achour, Karima ; Arame, Alex ; Dujon, Antoine ; Le Pimpec Barthes, Françoise ; Riquet, Marc</creatorcontrib><description>OBJECTIVES
Only patients with a complete resection of non-small-cell lung cancer (NSCLC) may expect long-term survival. Despite the recent progress in imaging and induction therapy, a thoracotomy may remain exploratory or with incomplete resection (R2). Our purpose was to revisit these situations.
METHODS
A total of 5305 patients who underwent surgery for NSCLC between 1980 and 2009 were reviewed. We compared the epidemiology, pathology, causes and prognosis characteristics of exploratory thoracotomy (ET) and R2 resections.
RESULTS
ET and R2 resections were observed in 223 (4%) and 197 (4%) patients, respectively. The frequency of ET decreased with time, while the frequency of R2 resection remained almost stable. The indications for ET and R2 resections were not significantly different. In comparison with ET, R2 resections were characterized by a significantly higher frequency of induction therapy (22 vs 17%, P < 10−3), adenocarcinomas (49 vs 15%, P < 10−6), T1-T2 (53 vs 29%, P < 10−6) and N0-N1 extension (67 vs 42%, P = 10−6). R2 resections were also characterized by a higher rate of postoperative complications (19.1 vs 9.9%, P = 0.014), with no significant difference in postoperative mortality (6.9 vs 4.9%, P = non significant). R2 resections resulted in a higher 5-year survival compared with ET (11.1 vs 1.2%, P = 10−3). There was no long-term survivor after ET, except during the last decade.
CONCLUSIONS
ET and R2 remain unavoidable. In comparison with ET, R2 resection is associated with a higher rate of postoperative complications, but a higher long-term survival.</description><identifier>ISSN: 1569-9293</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1093/icvts/ivs512</identifier><identifier>PMID: 23343836</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - secondary ; Carcinoma, Non-Small-Cell Lung - surgery ; Female ; France ; Humans ; Intraoperative Period ; Kaplan-Meier Estimate ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Lung Neoplasms - surgery ; Male ; Middle Aged ; Neoplasm, Residual ; Original ; Pneumonectomy - adverse effects ; Pneumonectomy - mortality ; Retrospective Studies ; Risk Factors ; Thoracotomy - adverse effects ; Thoracotomy - mortality ; Time Factors ; Treatment Outcome</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2013-05, Vol.16 (5), p.667-672</ispartof><rights>The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-33caca49a89077cd89a651e41c45e0e4298d59153265f6dfdf946aeab19f05143</citedby><cites>FETCH-LOGICAL-c416t-33caca49a89077cd89a651e41c45e0e4298d59153265f6dfdf946aeab19f05143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630409/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630409/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1603,27922,27923,53789,53791</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/icvts/ivs512$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23343836$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Foucault, Christophe</creatorcontrib><creatorcontrib>Mordant, Pierre</creatorcontrib><creatorcontrib>Grand, Bertrand</creatorcontrib><creatorcontrib>Achour, Karima</creatorcontrib><creatorcontrib>Arame, Alex</creatorcontrib><creatorcontrib>Dujon, Antoine</creatorcontrib><creatorcontrib>Le Pimpec Barthes, Françoise</creatorcontrib><creatorcontrib>Riquet, Marc</creatorcontrib><title>Unexpected extensions of non-small-cell lung cancer diagnosed during surgery: revisiting exploratory thoracotomies and incomplete resections</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>OBJECTIVES
Only patients with a complete resection of non-small-cell lung cancer (NSCLC) may expect long-term survival. Despite the recent progress in imaging and induction therapy, a thoracotomy may remain exploratory or with incomplete resection (R2). Our purpose was to revisit these situations.
METHODS
A total of 5305 patients who underwent surgery for NSCLC between 1980 and 2009 were reviewed. We compared the epidemiology, pathology, causes and prognosis characteristics of exploratory thoracotomy (ET) and R2 resections.
RESULTS
ET and R2 resections were observed in 223 (4%) and 197 (4%) patients, respectively. The frequency of ET decreased with time, while the frequency of R2 resection remained almost stable. The indications for ET and R2 resections were not significantly different. In comparison with ET, R2 resections were characterized by a significantly higher frequency of induction therapy (22 vs 17%, P < 10−3), adenocarcinomas (49 vs 15%, P < 10−6), T1-T2 (53 vs 29%, P < 10−6) and N0-N1 extension (67 vs 42%, P = 10−6). R2 resections were also characterized by a higher rate of postoperative complications (19.1 vs 9.9%, P = 0.014), with no significant difference in postoperative mortality (6.9 vs 4.9%, P = non significant). R2 resections resulted in a higher 5-year survival compared with ET (11.1 vs 1.2%, P = 10−3). There was no long-term survivor after ET, except during the last decade.
CONCLUSIONS
ET and R2 remain unavoidable. In comparison with ET, R2 resection is associated with a higher rate of postoperative complications, but a higher long-term survival.</description><subject>Aged</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - secondary</subject><subject>Carcinoma, Non-Small-Cell Lung - surgery</subject><subject>Female</subject><subject>France</subject><subject>Humans</subject><subject>Intraoperative Period</subject><subject>Kaplan-Meier Estimate</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm, Residual</subject><subject>Original</subject><subject>Pneumonectomy - adverse effects</subject><subject>Pneumonectomy - mortality</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Thoracotomy - adverse effects</subject><subject>Thoracotomy - mortality</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1569-9293</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UbFuFDEQtRCIJAcdNXIHBUvs9XqzpkBCEYFIkdKQ2nLs2YuR11483lPuH_hofLlwgibVjGbevDd6j5A3nH3kTIlTbzcFT_0GJW-fkWMue9WodpDPD70SR-QE8SdjXDHBXpKjVohODKI_Jr9vItzPYAs4CvcFIvoUkaaRxhQbnEwIjYUQaFjimloTLWTqvFnHhPXELdnXOS55DXn7iWbYePRlN6u0IWVTUt7Sclc7m0qaPCA10VEfbZrmAAXqDVb9newr8mI0AeH1Y12Rm4uvP86_N1fX3y7Pv1w1tuN9aYSwxppOmUGxszPrBmV6yaHjtpPAoGvV4KTiUrS9HHs3ulF1vQFzy9XIJO_Einze887L7QTOQizZBD1nP5m81cl4_f8m-ju9ThstesG6avqKvH8kyOnXAlj05HFnk4mQFtRcVHeVGGpdkQ97qM0JMcN4kOFM7wLUDwHqfYAV_vbf1w7gv4lVwLs9IC3z01R_AEUyrDs</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Foucault, Christophe</creator><creator>Mordant, Pierre</creator><creator>Grand, Bertrand</creator><creator>Achour, Karima</creator><creator>Arame, Alex</creator><creator>Dujon, Antoine</creator><creator>Le Pimpec Barthes, Françoise</creator><creator>Riquet, Marc</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130501</creationdate><title>Unexpected extensions of non-small-cell lung cancer diagnosed during surgery: revisiting exploratory thoracotomies and incomplete resections</title><author>Foucault, Christophe ; Mordant, Pierre ; Grand, Bertrand ; Achour, Karima ; Arame, Alex ; Dujon, Antoine ; Le Pimpec Barthes, Françoise ; Riquet, Marc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-33caca49a89077cd89a651e41c45e0e4298d59153265f6dfdf946aeab19f05143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - secondary</topic><topic>Carcinoma, Non-Small-Cell Lung - surgery</topic><topic>Female</topic><topic>France</topic><topic>Humans</topic><topic>Intraoperative Period</topic><topic>Kaplan-Meier Estimate</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm, Residual</topic><topic>Original</topic><topic>Pneumonectomy - adverse effects</topic><topic>Pneumonectomy - mortality</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Thoracotomy - adverse effects</topic><topic>Thoracotomy - mortality</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Foucault, Christophe</creatorcontrib><creatorcontrib>Mordant, Pierre</creatorcontrib><creatorcontrib>Grand, Bertrand</creatorcontrib><creatorcontrib>Achour, Karima</creatorcontrib><creatorcontrib>Arame, Alex</creatorcontrib><creatorcontrib>Dujon, Antoine</creatorcontrib><creatorcontrib>Le Pimpec Barthes, Françoise</creatorcontrib><creatorcontrib>Riquet, Marc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Foucault, Christophe</au><au>Mordant, Pierre</au><au>Grand, Bertrand</au><au>Achour, Karima</au><au>Arame, Alex</au><au>Dujon, Antoine</au><au>Le Pimpec Barthes, Françoise</au><au>Riquet, Marc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unexpected extensions of non-small-cell lung cancer diagnosed during surgery: revisiting exploratory thoracotomies and incomplete resections</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>16</volume><issue>5</issue><spage>667</spage><epage>672</epage><pages>667-672</pages><issn>1569-9293</issn><eissn>1569-9285</eissn><abstract>OBJECTIVES
Only patients with a complete resection of non-small-cell lung cancer (NSCLC) may expect long-term survival. Despite the recent progress in imaging and induction therapy, a thoracotomy may remain exploratory or with incomplete resection (R2). Our purpose was to revisit these situations.
METHODS
A total of 5305 patients who underwent surgery for NSCLC between 1980 and 2009 were reviewed. We compared the epidemiology, pathology, causes and prognosis characteristics of exploratory thoracotomy (ET) and R2 resections.
RESULTS
ET and R2 resections were observed in 223 (4%) and 197 (4%) patients, respectively. The frequency of ET decreased with time, while the frequency of R2 resection remained almost stable. The indications for ET and R2 resections were not significantly different. In comparison with ET, R2 resections were characterized by a significantly higher frequency of induction therapy (22 vs 17%, P < 10−3), adenocarcinomas (49 vs 15%, P < 10−6), T1-T2 (53 vs 29%, P < 10−6) and N0-N1 extension (67 vs 42%, P = 10−6). R2 resections were also characterized by a higher rate of postoperative complications (19.1 vs 9.9%, P = 0.014), with no significant difference in postoperative mortality (6.9 vs 4.9%, P = non significant). R2 resections resulted in a higher 5-year survival compared with ET (11.1 vs 1.2%, P = 10−3). There was no long-term survivor after ET, except during the last decade.
CONCLUSIONS
ET and R2 remain unavoidable. In comparison with ET, R2 resection is associated with a higher rate of postoperative complications, but a higher long-term survival.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>23343836</pmid><doi>10.1093/icvts/ivs512</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Interactive cardiovascular and thoracic surgery, 2013-05, Vol.16 (5), p.667-672 |
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| source | Oxford Open |
| subjects | Aged Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - secondary Carcinoma, Non-Small-Cell Lung - surgery Female France Humans Intraoperative Period Kaplan-Meier Estimate Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - surgery Male Middle Aged Neoplasm, Residual Original Pneumonectomy - adverse effects Pneumonectomy - mortality Retrospective Studies Risk Factors Thoracotomy - adverse effects Thoracotomy - mortality Time Factors Treatment Outcome |
| title | Unexpected extensions of non-small-cell lung cancer diagnosed during surgery: revisiting exploratory thoracotomies and incomplete resections |
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