Current Thoracic Surgery 2024 , Vol 9 , Issue 1
Factors affecting clinical follow-up of patients who had extended resection due to non-small cell lung cancer with vertebral invasion
Bahar Ağaoğlu Şanlı1,Fatma İlknur Ulugün2,Fatma Mutlu2,Üstün Andaç Dinçtürk3,Volkan Karaçam2,Ömer Akçalı3,Aydın Şanlı1
1Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İzmir, Turkey
2Department of Thoracic Surgery, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
3Department of Orthopedics and Traumatology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
DOI : 10.26663/cts.2024.003 Viewed : 892 - Downloaded : 230 Background: Chest wall involvement or vertebral invasion can be detected in 8-15% of patients with nonsmall cell lung cancer. We aimed to evaluate the surgical treatment outcomes and factors affecting overall survival (OS) in those patients who underwent en-bloc resection due to vertebral and chest wall invasion.

Materials and Methods: The study encompassed 15 patients with locally advanced non-small cell lung cancer who underwent anatomical lung resection and various vertebral and/or chest wall resections because of vertebral invasion at our institution between 2007 and 2019. Demographic, clinical, and pathological data of these patients were collected retrospectively and the effects of these factors on surgical outcomes and survival were evaluated.

Results: The mean age of the 15 patients was 59.1 ± 10.2 years. Among the patients, six had adenocarcinoma (40%), five had squamous cell carcinoma (33.3%), one had large cell neuroendocrine carcinoma (6.7%), two had a combination of large cell neuroendocrine and adenocarcinoma (13.3%), and one had pleomorphic cell carcinoma (6.7%). Simultaneous to lung resection, hemicorpectomy in four patients (26.6%), total vertebrectomy in one patient (6.6%), partial corpectomy in three patients (20.0%), en-bloc transversectomy in five patients (33.3%), hemilaminectomy in two patients (13.3%) were performed. Two patients underwent only vertebra resection, while 13 patients underwent partial rib resection along with the vertebra. The median overall survival (OS) was 26.3 months (14.7-37.8). The postoperative survival rates were 93%, and 33% for 30-day, and 3-year respectively. When comparing OS among histopathological subgroups, no statistically significant difference was observed (p = 0.473). The median OS was 9.2 months for patients who underwent only vertebra resection, while it was 26.3 months for those who underwent vertebra and rib resection (p = 0.534). Other clinical features such as neoadjuvant treatment status, surgical margin positivity, and presence of recurrence did not exhibit a statistically significant impact on the patients' survival.

Conclusions: En-bloc resection is a treatment alternative that can be successfully applied in patients with primary lung malignancies together with vertebral invasion. Nonetheless, chemotherapy, radiotherapy, or immunotherapy is advised for disease management during the postoperative period. Keywords : vertebral invasion, non-small cell lung cancer, extended resection