Surgical results and long-term follow-up of T(4)-non-small cell lung cancer invading the left atrium or the intrapericardial base of the pulmonary veins

Abstract

Patients with locally advanced non-small cell lung cancer infiltrating the left atrium (LA) or the intrapericardial base of the pulmonary veins (PVs) are generally not considered good candidates for surgery because of the poor long-term survival. In the last 10 years, 31 consecutive patients with non-small cell lung cancer directly invading the LA or the intrapericardial base of the PVs underwent surgery. Pneumonectomy was the operation performed most frequently. In-hospital mortality was 9.7% and overall morbidity was 52%. One-, 2- and 3-year survival rates were 64, 46 and 30%, respectively with a mean survival of 22 months. The systemic recurrence of disease was the major cause of death at follow-up. At statistical analyses, the N-factor and the type of operation were related to poor long-term survival. In these patients, surgery could be performed with an acceptable operative mortality and morbidity. Surgery should be considered whenever a complete resection is technically possible. A careful preoperative evaluation is mandatory to select good candidates for surgery.

Figure 1:

Preoperative axial CT scan of two different patients; (a) invasion of the intrapericardial base of the superior right PV, a spread of the tumour was visible inside the lumen of the vein towards the LA chambers (black arrow); (b) direct invasion of the LA wall, the tumour protruding inside the LA chamber (black arrow).

Figure 2:

Analyses of mean survivals using Kaplan–Meier curves and long-rank test. (a) The overall long-term survival curve; (b) disease-free survival curve.

Figure 3:

Kaplan–Meier curves stratified for pN_0–1 or pN₂ lymph node status.