Kumar Naveen, Malik Prabhat Singh, Bharati Sachidanand Jee, Yadav Mukesh, Jain Deepali, Kumar Sunil
Department of Surgical Oncology, BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Department of Medical Oncology, BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Lung India. 2021 Jul-Aug;38(4):338-342. doi: 10.4103/lungindia.lungindia_725_20.
The incidence of lung cancer with chest wall (CW) involvement is approximately 5%. Surgical resection with tumor-free margin is the mainstay of the treatment but these patients generally require multimodality management. CW resection for lung cancer is a complex procedure and requires a balance of radical oncological resection and reconstruction. Herein, we shared an experience of primary lung cancer with CW involvement.
Outcome analysis of a prospectively maintained lung cancer database was done for the patients having primary lung cancer with CW involvement. All the patients underwent radical surgical resection of the primary tumor along with the CW.
Among the 208 patients undergoing surgery for non-small cell lung cancer, 20 (9.5%) were found to have CW involvement radiologically. The most common symptom was chronic cough. A total of 11 patients received neoadjuvant chemotherapy (NACT) and the rest were taken for upfront surgery. Six patients had a partial response to NACT and none of them had tumor progression during the chemotherapy. All the patients underwent en bloc resection of the CW with anatomical resection of lung and systematic mediastinal lymphadenectomy. The mean duration of surgery was 199 min and the average blood loss was 560 ml. Reconstruction was done with a combination of prosthetic mesh and pedicled muscle flap. Median disease-free and overall survivals were 21 and 26 months, respectively.
Radical resection with reconstruction is required for optimal long-term oncological and functional outcomes for NSCLC with CW involvement.
肺癌侵犯胸壁（CW）的发生率约为5%。实现切缘无肿瘤的手术切除是主要治疗手段，但这些患者通常需要多模式管理。肺癌的胸壁切除是一个复杂的手术，需要在根治性肿瘤切除和重建之间取得平衡。在此，我们分享了一例原发性肺癌侵犯胸壁的经验。
对前瞻性维护的肺癌数据库中患有原发性肺癌侵犯胸壁的患者进行结果分析。所有患者均接受了原发性肿瘤连同胸壁的根治性手术切除。
在208例接受非小细胞肺癌手术的患者中，20例（9.5%）经影像学检查发现有胸壁侵犯。最常见的症状是慢性咳嗽。共有11例患者接受了新辅助化疗（NACT），其余患者接受了直接手术。6例患者对NACT有部分反应，且在化疗期间均无肿瘤进展。所有患者均接受了胸壁整块切除，同时进行了肺的解剖性切除和系统性纵隔淋巴结清扫。手术平均时长为199分钟，平均失血量为560毫升。采用人工补片和带蒂肌瓣联合进行重建。无病生存期和总生存期的中位数分别为21个月和26个月。
对于侵犯胸壁（CW）的非小细胞肺癌（NSCLC），为实现最佳的长期肿瘤学和功能结果，需要进行根治性切除并重建。
