org‑2
Original Article
Pleuropneumonectomy for diffuse pleural metastasis in primary lung cancer ABSTRACT Objective: The purpose of this study is to analyze a single institution experience with pleuropneumonectomy for pleural metastasis and malignant pleural effusion in primary lung cancer. Materials and Methods: From August 1978 to August 2011, 66 consecutive patients with lung cancer underwent pleuropneumonectomy. Patients were followed‑up after the operation. The quality‑of‑life and the survival time were recorded. Results: All the 66 patients were successfully operated on, including 38 patients in early years (1978‑1993) and 28 patients in recent years (1994‑2011). Two patients in early years died after the operation. Post‑operative complications occurred including heart arrhythmia, respiratory insufficiency and bacterial infection of residual lung, chylothoraxin and mental disorder. A total of 61 patients have been successfully followed‑up and three patients in early years were lost in 1 year after the operation. Local recurrence was found in seven cases (4 in early years, 3 in recent years) and distant metastasis was found in 48 cases (29 in early years, 19 in recent years). A total of 54 patients died from tumors, seven patients survived. The actuarial 1, 2 and 3‑year survival rates are 72.7%, 27.2% and 6.1% of 36 in patients of early years and 85.7%, 46.4% and 21.4% in 28 patients of recent years. The mean survival and the median survival of the total 64 patients were 20.0 ± 10.9 months and 17 months respectively. Further analysis showed that the mean survival and the median survival of the 36 patients in early years were 17.2 ± 9.7 months and 15 months, in contrast to 23.4 ± 11.3 months and 18 months of the 28 patients in recent years. Conclusion: Pleuropneumonectomy is an option of patients with advanced‑stage lung cancer associated with uncontrolled malignant pleural fluid by conservative therapies. Strict selection of patient to be operated, careful procedures to eradicate obvious tumors and metastasis and enhanced post‑operative combined therapy are beneficial to patients’ long‑term survival. KEY WORDS: Long‑term survival, lung cancer, operative risk, pleuropneumonectomy, pneumonectomy
INTRODUCTION
MATERIALS AND METHODS
Ac c o rd i n g t o t h e l a t e s t t u m o r n o d e metastases (TNM)/International Union Against Cancer (UICC) classification, lung cancer with diffuse pleural metastasis and malignant pleural effusion is classified as stage IV.[1] These patients are usually not indicated for surgery due to the impossibility of complete resection of lung cancer with pleural dissemination. Hence, they have to be treated conservatively with the purpose of control of pleural effusion.[2] Thus, their prognoses are usually poor. At present, the optimal therapy for these patients is still in dispute. Many questions need to be answered, such as whether they should be operated and what is the optimal operative procedure.[3,4] The purpose of this study is to analyze 66 consecutive pleuropneumonectomies performed on cancer patients aimed at identifying factors that affect morbidity, immediate results and long‑term survival.
From August 1978 to August 2011, total of 837 patients in our department had received pneumonectomy, including 74 patients who received pleuropneumonectomy. Among the 74 patients underwent pleuropneumonectomy, there were 66 patients with lung cancer, five patients with mesothelioma and two patients with malignant thymoma and one patient with tuberculous empyema. The 66 patients with lung cancer and underwent pleuropneumonectomy were included in our research, including 38 males and 28 females, with the mean age of 54 years (ranging from 35 to 68 years). All the patients had received certain conservative treatments, such as chemotherapy, radiotherapy, thoracentesis, thoracic instilling chemotherapy or chest drainage. However, malignant pleural fluids in most patients were poorly controlled. Most of the patients were examined by computed tomographic (CT) scan, technetium bone scan, cardiac ultrasound, bronchoscopy and pulmonary function tests prior
S92
Wen‑Bo Jin, Chao‑Yang Liang1,*, Yang‑Hong Peng2, Nai‑Kang Zhou Departments of Thoracic Surgery, Chinese People’s Liberation Army Medical School, 1 People’s Liberation Army General Hospital, Beijing 100853, 2People’s Liberation Army 309th Hospital, Beijing 100091, China *Co-first author For correspondence: Prof. Nai-Kang Zhou, Department of Thoracic Surgery, People’s Liberation Army General Hospital, Beijing 100853, China. E‑mail: znkljp@sina. com
Access this article online Website: www.cancerjournal.net DOI: 10.4103/0973-1482.119115 PMID: *** Quick Response Code:
Journal of Cancer Research and Therapeutics - Supplement 2 - 2013 - Volume 9
Jin, et al.: Pleuropneumonectomy for Lung Cancer
to operation. Patients with primary carcinoma and merely local metastasis in homolateral thorax were subject to the operation. Patients with reduced pulmonary function received a quantitative pulmonary perfusion scan.
using 2‑test or Fisher’s exact test. A P
Original Article
Pleuropneumonectomy for diffuse pleural metastasis in primary lung cancer ABSTRACT Objective: The purpose of this study is to analyze a single institution experience with pleuropneumonectomy for pleural metastasis and malignant pleural effusion in primary lung cancer. Materials and Methods: From August 1978 to August 2011, 66 consecutive patients with lung cancer underwent pleuropneumonectomy. Patients were followed‑up after the operation. The quality‑of‑life and the survival time were recorded. Results: All the 66 patients were successfully operated on, including 38 patients in early years (1978‑1993) and 28 patients in recent years (1994‑2011). Two patients in early years died after the operation. Post‑operative complications occurred including heart arrhythmia, respiratory insufficiency and bacterial infection of residual lung, chylothoraxin and mental disorder. A total of 61 patients have been successfully followed‑up and three patients in early years were lost in 1 year after the operation. Local recurrence was found in seven cases (4 in early years, 3 in recent years) and distant metastasis was found in 48 cases (29 in early years, 19 in recent years). A total of 54 patients died from tumors, seven patients survived. The actuarial 1, 2 and 3‑year survival rates are 72.7%, 27.2% and 6.1% of 36 in patients of early years and 85.7%, 46.4% and 21.4% in 28 patients of recent years. The mean survival and the median survival of the total 64 patients were 20.0 ± 10.9 months and 17 months respectively. Further analysis showed that the mean survival and the median survival of the 36 patients in early years were 17.2 ± 9.7 months and 15 months, in contrast to 23.4 ± 11.3 months and 18 months of the 28 patients in recent years. Conclusion: Pleuropneumonectomy is an option of patients with advanced‑stage lung cancer associated with uncontrolled malignant pleural fluid by conservative therapies. Strict selection of patient to be operated, careful procedures to eradicate obvious tumors and metastasis and enhanced post‑operative combined therapy are beneficial to patients’ long‑term survival. KEY WORDS: Long‑term survival, lung cancer, operative risk, pleuropneumonectomy, pneumonectomy
INTRODUCTION
MATERIALS AND METHODS
Ac c o rd i n g t o t h e l a t e s t t u m o r n o d e metastases (TNM)/International Union Against Cancer (UICC) classification, lung cancer with diffuse pleural metastasis and malignant pleural effusion is classified as stage IV.[1] These patients are usually not indicated for surgery due to the impossibility of complete resection of lung cancer with pleural dissemination. Hence, they have to be treated conservatively with the purpose of control of pleural effusion.[2] Thus, their prognoses are usually poor. At present, the optimal therapy for these patients is still in dispute. Many questions need to be answered, such as whether they should be operated and what is the optimal operative procedure.[3,4] The purpose of this study is to analyze 66 consecutive pleuropneumonectomies performed on cancer patients aimed at identifying factors that affect morbidity, immediate results and long‑term survival.
From August 1978 to August 2011, total of 837 patients in our department had received pneumonectomy, including 74 patients who received pleuropneumonectomy. Among the 74 patients underwent pleuropneumonectomy, there were 66 patients with lung cancer, five patients with mesothelioma and two patients with malignant thymoma and one patient with tuberculous empyema. The 66 patients with lung cancer and underwent pleuropneumonectomy were included in our research, including 38 males and 28 females, with the mean age of 54 years (ranging from 35 to 68 years). All the patients had received certain conservative treatments, such as chemotherapy, radiotherapy, thoracentesis, thoracic instilling chemotherapy or chest drainage. However, malignant pleural fluids in most patients were poorly controlled. Most of the patients were examined by computed tomographic (CT) scan, technetium bone scan, cardiac ultrasound, bronchoscopy and pulmonary function tests prior
S92
Wen‑Bo Jin, Chao‑Yang Liang1,*, Yang‑Hong Peng2, Nai‑Kang Zhou Departments of Thoracic Surgery, Chinese People’s Liberation Army Medical School, 1 People’s Liberation Army General Hospital, Beijing 100853, 2People’s Liberation Army 309th Hospital, Beijing 100091, China *Co-first author For correspondence: Prof. Nai-Kang Zhou, Department of Thoracic Surgery, People’s Liberation Army General Hospital, Beijing 100853, China. E‑mail: znkljp@sina. com
Access this article online Website: www.cancerjournal.net DOI: 10.4103/0973-1482.119115 PMID: *** Quick Response Code:
Journal of Cancer Research and Therapeutics - Supplement 2 - 2013 - Volume 9
Jin, et al.: Pleuropneumonectomy for Lung Cancer
to operation. Patients with primary carcinoma and merely local metastasis in homolateral thorax were subject to the operation. Patients with reduced pulmonary function received a quantitative pulmonary perfusion scan.
using 2‑test or Fisher’s exact test. A P
