Chan Deana G, Okai Bernard K, Lipinski Lindsay J, Hennon Mark W, Yendamuri Sai, Farrugia Mark, Fabiano Andrew J
Department of Neuro-Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Neurosurg Pract. 2025 Sep 24;6(4):e000168. doi: 10.1227/neuprac.0000000000000168. eCollection 2025 Dec.
Surgical management of Pancoast tumors requires collaboration between thoracic surgeons and neurosurgeons. Minimal literature exists on the management of these patients from a neurosurgical perspective regarding operative technique and its impact on short-term neurological function and long-term survival.
Patients at a National Cancer Institute-designated cancer center were prospectively enrolled in an Institutional Review Board-approved study. Those patients surgically treated for Pancoast tumors were identified. Patient demographics, tumor characteristics, preoperative and postoperative measurements, and discharge disposition were collected. Outcome measures included neurological function and overall survival. Basic descriptive statistics were performed to summarize cumulative data for each measurement recorded.
Nineteen patients were included in the study. The mean age was 59 + 7.88 years, and 42.11% (n = 8) were female. 43.75% (n = 7) were staged as T3 and 56.25% (n = 9) as T4. 89.47% (n = 17) had preoperative chemoradiotherapy (Table 1). 89.47% (n = 17) and 21.05% (n = 4) presented with upper extremity pain and paresthesia, respectively. 57.89% (n = 11) presented with respiratory symptoms. The mean time from diagnosis to surgery was 143.53 + 39.87 days (Table 2). 100% underwent resection of apical tumor and chest wall, with complete removal achieved in 89.47% (n = 17). Complications occurred in of 21.05% (n = 4) patients, no major complications. Average follow-up was 3.83 + 3.11 years. 10.53% (n = 2) had decrease in motor function from baseline ( = .162), whereas sensation remained intact and unchanged for all patients. 42.11% (n = 8) had tumor recurrence, with an average of 0.91 years from tumor resection. There were 26.32% (n = 5) patients who were deceased at an average of 1.65 + 1.15 years (Table 3).
Our case series highlights the importance of neurosurgical involvement and expected outcomes in managing Pancoast tumors. Given the neurosurgeon's critical role in tumor resection, further studies highlighting neurosurgical management of Pancoast tumors are warranted.
肺上沟瘤的外科治疗需要胸外科医生和神经外科医生的协作。从神经外科角度，关于这些患者的手术技术及其对短期神经功能和长期生存的影响，现有文献极少。
在一所美国国立癌症研究所指定的癌症中心，前瞻性纳入经机构审查委员会批准的研究中的患者。确定那些接受肺上沟瘤手术治疗的患者。收集患者的人口统计学资料、肿瘤特征、术前和术后测量数据以及出院情况。结果指标包括神经功能和总生存期。进行基本描述性统计以总结所记录的每项测量的累积数据。
19例患者纳入研究。平均年龄为59±7.88岁，42.11%（n = 8）为女性。43.75%（n = 7）为T3期，56.25%（n = 9）为T4期。89.47%（n = 17）接受过术前放化疗（表1）。分别有89.47%（n = 17）和21.05%（n = 4）出现上肢疼痛和感觉异常。57.89%（n = 11）出现呼吸道症状。从诊断到手术的平均时间为143.53±39.87天（表2）。100%的患者接受了肺尖肿瘤和胸壁切除术，89.47%（n = 17）实现了完全切除。21.05%（n = 4）的患者发生并发症，无重大并发症。平均随访时间为3.83±3.11年。10.53%（n = 2）的患者运动功能较基线下降（P = 0.162），而所有患者感觉保持完整且无变化。42.11%（n = 8）出现肿瘤复发，从肿瘤切除到复发平均为0.91年。26.32%（n = 5）的患者死亡，平均死亡时间为1.65±1.15年（表3）。
我们的病例系列强调了神经外科参与及肺上沟瘤治疗预期结果的重要性。鉴于神经外科医生在肿瘤切除中的关键作用，有必要开展更多突出肺上沟瘤神经外科治疗的研究。
