Is extended resection for locally advanced thoracic cancer with cardiopulmonary bypass justified?
Cardiopulmonary bypass (CPB)
Extended resection
Locally advanced thoracic cancer
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
26 Oct 2024
26 Oct 2024
Historique:
received:
04
06
2024
accepted:
14
10
2024
medline:
27
10
2024
pubmed:
27
10
2024
entrez:
27
10
2024
Statut:
epublish
Résumé
Resection of intrathoracic tumor with cardiopulmonary bypass (CPB) remains a relatively under-reported intervention in literature, and its role in managing locally advanced mediastinal and lung cancers is a topic of ongoing debate. Our aim was to review our experience and assess the role of CPB for treating locally advanced mediastinal and lung cancers. Between 2015 and 2020, this study initially included 10 patients with primary locally advanced thoracic malignancies with apparent adjacent cardiovascular invasion demonstrated by thoracic imaging scans. Operation was performed based on a multidisciplinary tumor board consensus. Eventually, 8 patients (3 primary lung cancers and 5 mediastinal cancers) received either salvage or elective resection with CPB; two completed surgery without requiring CPB. Regarding the extent of adjacent structure involvement, 4 patients presented with involvement of the superior vena cava (SVC), 1 involved the right atrium (RA), 2 involved the SVC and RA, and 1 involved the SVC, the origin of main pulmonary artery, and the ascending aorta. Thirty-day mortality occurred in two of three patients receiving salvage surgery due to respiratory insufficiency. With the long-term follow-up, one patient died of recurrence 25 months postoperatively, one survived with recurrence 30 months postoperatively, and four were alive without recurrence for 35, 36, 49, and 107 months after operations. In certain patients, particularly for elective surgical candidates rather than salvage resection, CPB allows for extended resection of locally advanced thoracic cancers with acceptable perioperative safety and survival.
Sections du résumé
BACKGROUND
BACKGROUND
Resection of intrathoracic tumor with cardiopulmonary bypass (CPB) remains a relatively under-reported intervention in literature, and its role in managing locally advanced mediastinal and lung cancers is a topic of ongoing debate. Our aim was to review our experience and assess the role of CPB for treating locally advanced mediastinal and lung cancers.
METHODS
METHODS
Between 2015 and 2020, this study initially included 10 patients with primary locally advanced thoracic malignancies with apparent adjacent cardiovascular invasion demonstrated by thoracic imaging scans. Operation was performed based on a multidisciplinary tumor board consensus. Eventually, 8 patients (3 primary lung cancers and 5 mediastinal cancers) received either salvage or elective resection with CPB; two completed surgery without requiring CPB.
RESULTS
RESULTS
Regarding the extent of adjacent structure involvement, 4 patients presented with involvement of the superior vena cava (SVC), 1 involved the right atrium (RA), 2 involved the SVC and RA, and 1 involved the SVC, the origin of main pulmonary artery, and the ascending aorta. Thirty-day mortality occurred in two of three patients receiving salvage surgery due to respiratory insufficiency. With the long-term follow-up, one patient died of recurrence 25 months postoperatively, one survived with recurrence 30 months postoperatively, and four were alive without recurrence for 35, 36, 49, and 107 months after operations.
CONCLUSION
CONCLUSIONS
In certain patients, particularly for elective surgical candidates rather than salvage resection, CPB allows for extended resection of locally advanced thoracic cancers with acceptable perioperative safety and survival.
Identifiants
pubmed: 39462357
doi: 10.1186/s12893-024-02632-8
pii: 10.1186/s12893-024-02632-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
334Informations de copyright
© 2024. The Author(s).
Références
Langer NB, Mercier O, Fabre D, Lawton J, Mussot S, Dartevelle P, et al. Outcomes after resection of T4 Non-small Cell Lung Cancer using cardiopulmonary bypass. Ann Thorac Surg. 2016;102(3):902–10.
doi: 10.1016/j.athoracsur.2016.03.044
pubmed: 27209605
Ried M, Neu R, Schalke B, von Susskind-Schwendi M, Sziklavari Z, Hofmann HS. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg. 2015;10:137.
doi: 10.1186/s13019-015-0346-2
pubmed: 26515387
pmcid: 4627626
Muralidaran A, Detterbeck FC, Boffa DJ, Wang Z, Kim AW. Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass: a systematic review. J Thorac Cardiovasc Surg. 2011;142(5):1137–42.
doi: 10.1016/j.jtcvs.2011.07.042
pubmed: 21864854
De Giacomo T, Patella M, Mazzesi G, Venuta F. Successful resection of thymoma directly invading the right atrium under cardiopulmonary bypass. Eur J Cardiothorac Surg. 2015;48(2):332–3.
doi: 10.1093/ejcts/ezu376
pubmed: 25293404
Filippou D, Kleontas A, Tentzeris V, Emmanouilides C, Tryfon S, Baka S, et al. Extended resections for the treatment of patients with T4 stage IIIA non-small cell lung cancer (NSCLC) (T(4)N(0–1)M(0)) with or without cardiopulmonary bypass: a 15-year two-center experience. J Thorac Dis. 2019;11(12):5489–501.
doi: 10.21037/jtd.2019.11.33
pubmed: 32030268
pmcid: 6987995
Wiebe K, Baraki H, Macchiarini P, Haverich A. Extended pulmonary resections of advanced thoracic malignancies with support of cardiopulmonary bypass. Eur J Cardiothorac Surg. 2006;29(4):571–7. discussion 7–8.
doi: 10.1016/j.ejcts.2005.10.041
pubmed: 16376094
Chen L, Zhu X, Zhu R, Jin X, Tan L, Chen Y. Cardiopulmonary bypass does not consequentially contribute to postoperative distant metastasis of giant refractory thoracic tumors: a retrospective study with long-term follow-up. Thorac Cancer. 2021;12(22):2990–5.
doi: 10.1111/1759-7714.14162
pubmed: 34532966
pmcid: 8590891
D’Andrilli A, Maurizi G, Ciccone AM, Ibrahim M, Andreetti C, De Benedictis I, et al. Reconstruction of the heart and the aorta for radical resection of lung cancer. J Thorac Cardiovasc Surg. 2024;167(4):1481–9.
doi: 10.1016/j.jtcvs.2023.07.041
pubmed: 37541573
Pinto CA, Marcella S, August DA, Holland B, Kostis JB, Demissie K. Cardiopulmonary bypass has a modest association with cancer progression: a retrospective cohort study. BMC Cancer. 2013;13:519.
doi: 10.1186/1471-2407-13-519
pubmed: 24180710
pmcid: 3831257
Mei J, Pu Q, Zhu Y, Ma L, Ren F, Che G, et al. Reconstruction of the pulmonary trunk via cardiopulmonary bypass in extended resection of locally advanced lung malignancies. J Surg Oncol. 2012;106(3):311–5.
doi: 10.1002/jso.22159
pubmed: 22124972
Weder W. Editorial comment: extended pulmonary resections of advanced thoracic malignancies with support of cardio-pulmonary bypass — is surgery justified? Eur J Cardio-Thoracic Surg April. 2006;29(4):577–8.
doi: 10.1016/j.ejcts.2006.02.021
Kao CN, Chou SH, Huang CL, Lin CH, Chiang HH, Lee JY, et al. Salvage surgery using simultaneous clamshell thoracotomy with median sternotomy for mediastinal growing teratoma syndrome. Thorac Cancer. 2020;11(3):785–8.
doi: 10.1111/1759-7714.13297
pubmed: 31925930
pmcid: 7049485
Menager JB, Mercier O, Levy A, Botticella A, Pradere P, Fabre D, et al. Outcomes of extended resection for locally advanced thymic malignancies. Respir Med Res. 2023;83:101009.
pubmed: 37087902
Yokoi K, Taniguchi T, Usami N, Kawaguchi K, Fukui T, Ishiguro F. Surgical management of locally advanced lung cancer. Gen Thorac Cardiovasc Surg. 2014;62(9):522–30.
doi: 10.1007/s11748-014-0425-7
pubmed: 24871783
Chambers A, Routledge T, Bille A, Scarci M. Does surgery have a role in T4N0 and T4N1 lung cancer? Interact Cardiovasc Thorac Surg. 2010;11(4):473–9.
doi: 10.1510/icvts.2010.235119
pubmed: 20621998
Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC Lung Cancer Staging Project: proposals for revision of the TNM Stage groupings in the Forthcoming (Eighth) Edition of the TNM classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39–51.
doi: 10.1016/j.jtho.2015.09.009
pubmed: 26762738
Tosi D, Damarco F, Franzi S, Mohamed S, Palleschi A, Mendogni P. Outcomes of extended surgical resections for locally advanced thymic malignancies: a narrative review. Gland Surg. 2022;11(3):611–21.
doi: 10.21037/gs-21-642
pubmed: 35402207
pmcid: 8984987
Marulli G, Lucchi M, Margaritora S, Cardillo G, Mussi A, Cusumano G, et al. Surgical treatment of stage III thymic tumors: a multi-institutional review from four Italian centers. Eur J Cardiothorac Surg. 2011;39(3):e1–7.
doi: 10.1016/j.ejcts.2010.11.026
pubmed: 21193321
Moser B, Fadel E, Fabre D, Keshavjee S, de Perrot M, Thomas P, et al. Surgical therapy of thymic tumours with pleural involvement: an ESTS Thymic Working Group Project. Eur J Cardiothorac Surg. 2017;52(2):346–55.
doi: 10.1093/ejcts/ezx090
pubmed: 28449028
pmcid: 5848821
Luo DX, Huang MJ, Xiong B, Li T, Xie K, Chen FR, et al. Primary mediastinal sarcoma: surgical outcomes of 21 cases. Interact Cardiovasc Thorac Surg. 2013;17(6):982–6.
doi: 10.1093/icvts/ivt354
pubmed: 24027167
pmcid: 3829490
Zhang Z, Wang X, Zhou Z, Jiang G, Li Y. Surgical management of primary mediastinal mature teratoma: a single-center 20 years’ experience. Front Surg. 2022;9:902985.
doi: 10.3389/fsurg.2022.902985
pubmed: 36132208
pmcid: 9483009
Huang C, Sun YG, Wu QJ, Ma C, Jiao P, Wang YZ, et al. Surgical treatment of intermediate to high grade thymic neuroendocrine neoplasms: case series of five patients and literature review. Transl Cancer Res. 2022;11(10):3535–47.
doi: 10.21037/tcr-22-1150
pubmed: 36388024
pmcid: 9641081
Zamora AK, Zobel MJ, Ourshalimian S, Zhou S, Shillingford NM, Kim ES. The Effect of Gross Total Resection on patients with Pleuropulmonary Blastoma. J Surg Res. 2020;253:115–20.
doi: 10.1016/j.jss.2020.03.019
pubmed: 32353636
Eto R, Hoshino I, Takiguchi N, Tonooka T, Gunji H, Kuwayama N, et al. Surgical resection of undifferentiated pleomorphic sarcoma (UPS) with jejunal perforation, a suspected case of metastasis of lung cancer. Clin J Gastroenterol. 2021;14(5):1386–91.
doi: 10.1007/s12328-021-01483-7
pubmed: 34287777
Altieri B, La Salvia A, Modica R, Marciello F, Mercier O, Filosso PL et al. Recurrence-free survival in early and locally Advanced large cell neuroendocrine carcinoma of the lung after Complete Tumor Resection. J Pers Med. 2023;13(2):330.
Yang T, Hui R, Wu Q, Tian J, Chen H. An invasive thymoma extending into the superior vena cava and right atrium. Ann Transl Med. 2019;7(18):498.
doi: 10.21037/atm.2019.08.59
pubmed: 31700934
pmcid: 6803234
Dong YQ, Liang JS, Zhang XM, Zhu SB, Xu JH, Ji T, et al. Surgical treatment of an invasive thymoma extending into the superior vena cava and right atrium. World J Surg Oncol. 2014;12:6.
doi: 10.1186/1477-7819-12-6
pubmed: 24400724
pmcid: 3938044
Kono T, Amano J, Sakaguchi M, Kitahara H. Successful resection of cardiac metastatic liposarcoma extending into the SVC, right atrium, and right ventricle. J Card Surg. 2005;20(4):364–5.
doi: 10.1111/j.1540-8191.2005.200389.x
pubmed: 15985140
Koliakos E, Chiriatti E, Durham A, Gonzalez M, Krueger T, Grange JC, Delay D, Gex G, Christodoulou M, Perentes JY. Metachronous lung cancer resection on extracorporeal membrane oxygenation in a pneumonectomized and mediastinum irradiated patient. Video-assist Thorac Surg. 2020;5:39.
doi: 10.21037/vats-2020-lm-03
Migliore M, Halezeroglu S, Lerut A. Surgery for advanced lung and esophageal cancer: new horizons or false dawn? Future Oncol. 2018;14(6s):1–4.
doi: 10.2217/fon-2018-0212
pubmed: 29664357
Akchurin RS, Davidov MI, Partigulov SA, Brand JB, Shiriaev AA, Lepilin MG, et al. Cardiopulmonary bypass and cell-saver technique in combined oncologic and cardiovascular surgery. Artif Organs. 1997;21(7):763–5.
doi: 10.1111/j.1525-1594.1997.tb03738.x
pubmed: 9212954
Mork C, Gahl B, Eckstein F, Berdajs DA. Prolonged cardiopulmonary bypass time as predictive factor for bloodstream infection. Heliyon. 2023;9(6):e17310.
doi: 10.1016/j.heliyon.2023.e17310
pubmed: 37383209
pmcid: 10293714
Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22(6):814–22.
doi: 10.1053/j.jvca.2008.08.004
pubmed: 18948034
Byrne JG, Leacche M, Agnihotri AK, Paul S, Bueno R, Mathisen DJ, et al. The use of cardiopulmonary bypass during resection of locally advanced thoracic malignancies: a 10-year two-center experience. Chest. 2004;125(4):1581–6.
doi: 10.1378/chest.125.4.1581
pubmed: 15078778