The “cut-in patch-out” technique for Pancoast tumor resections results in postoperative pain reduction: a case control study

Journal of Cardiothoracic Surgery

Kenneth A Kesler³  Karen M Rieger²  DuyKhanh P Ceppa²  Thomas J Birdas²  Ikenna C Okereke¹  Daniel J Weber² 

[1] Division of Thoracic Surgery, The Rhode Island and Miriam Hospitals of Warren Alper Medical School of Brown University, Providence, RI, USA;Division of Cardiothoracic Surgery, Department of Surgery, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA;Department of Surgery, Cardiothoracic Division, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall 215, Indianapolis 46202, IN, USA

关键词: Pain;    Chest wall;    Lung cancer;    Pancoast tumor;   

Others  :  1151747
DOI  :  10.1186/s13019-014-0163-z

 received in 2014-07-12, accepted in 2014-09-25,  发布年份 2014

【 摘 要 】

Background

Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the chest wall defect. The defect is then patched at the completion of the procedure (¿cut-in patch-out¿) thereby avoiding a separate thoracotomy with rib spreading. We undertook a study to compare outcomes of this novel ¿cut-in patch-out¿ technique with traditional thoracotomy for patients with Pancoast tumors.

Methods

We retrospectively identified 41 patients undergoing surgical resection of Pancoast tumors requiring en-bloc removal of at least 3 ribs at our institution from 1999 to 2012. Surgery was accomplished by either a ¿cut-in patch-out¿ technique (n?=?25) or traditional posterolateral thoracotomy and separate chest wall resection (n?=?16). Multiple variables including patient demographics, neoadjuvant therapy, extent of resection, and pathology were analyzed with respect to outcomes from morbidity, narcotic use, and oncologic perspectives.

Results

Baseline demographics, neoadjuvant therapy, and perioperative factors including extent of surgery, complete resections (R0), nodal status and lymph node number, morbidity, and mortality were similar between the two groups. The mean duration of out-patient narcotic use was significantly lower in the ¿cut-in patch-out¿ group compared to the thoracotomy group (80.6 days?±?62.4 vs. 158.2 days?±?119.2, p?100 days). Additionally, five year survival for the ¿cut-in patch-out¿ group was 48% versus the traditional group at 12.5% (p?=?0.04).

Conclusions

Compared with a traditional thoracotomy and separate chest wall resection approach for P-NSCLC, a ¿cut-in patch-out¿ technique offers an alternative approach that appears to have at least oncologic equivalence while decreasing pain. We have more recently adapted this technique to select patients with pulmonary neoplasms involving chest wall invasion and believe further investigation is warranted.

【 授权许可】

   
2014 Weber et al.; licensee BioMed Central Ltd.

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【 参考文献 】

• [1]Pancoast H: Superior pulmonary sulcus tumor: tumor characterized by pain, horner¿s syndrome, destruction of bone and atrophy of hand muscles. JAMA 1932, 99:1391-1396.
• [2]Chardack W, MacCallum J: Pancoast syndrome due to bronchiogenic carcinoma: successful surgical removal and postoperative irradiation; a case report. J Thorac Surg 1953, 25:402-412.
• [3]Stoelben E, Ludwig C: Chest wall resection for lung cancer: indications and techniques. Eur J Cardiothorac Surg 2009, 35:450-456.
• [4]Rusch VW: Management of Pancoast tumours. Lancet Oncol 2006, 7:997-1005.
• [5]Detterbeck FC: Changes in the treatment of Pancoast tumors. Ann Thorac Surg 2003, 75:1990-1997.
• [6]Kinney MA, Hooten WM, Cassivi SD, Allen MS, Passe MA, Hanson AC, Schroeder DR, Mantilla CB: Chronic postthoracotomy pain and health-related quality of life. Ann Thorac Surg 2012, 93:1242-1247.
• [7]Akcali Y, Demir H, Tezcan B: The effect of standard posterolateral versus muscle-sparing thoracotomy on multiple parameters. Ann Thorac Surg 2003, 76:1050-1054.
• [8]Lemmer JH Jr, Gomez MN, Symreng T, Ross AF, Rossi NP: Limited lateral thoracotomy. Improved postoperative pulmonary function. Arch Surg 1990, 125:873-877.
• [9]Shaw RR, Paulson DL, Kee JL: Treatment of superior sulcus tumor by irradiation followed by resection. Ann Surg 1961, 154:29-40.
• [10]Kent MS, Bilsky MH, Rusch VW: Resection of superior sulcus tumors (posterior approach). Thorac Surg Clin 2004, 14:217-228.
• [11]Linden PA: Video-assisted anterior approach to Pancoast tumors. J Thorac Cardiovasc Surg 2010, 140:e38-e39.
• [12]Cheung IH, Lim E: Video-assisted thoracoscopic surgical lobectomy with limited en bloc resection of superior sulcus tumor. J Thorac Cardiovasc Surg 2012, 144:e148-e151.
• [13]Nicastri D, Swanson S: Pros and cons of anterior and posterior approaches to Pancoast tumors: posterolateral superior sulcus tumor resections. Oper Tech Thorac Cardiovasc Surg 2006, 11:141-153.
• [14]Keller SM, Carp NZ, Levy MN, Rosen SM: Chronic post thoracotomy pain. J Cardiovasc Surg (Torino) 1994, 35:161-164.
• [15]Rusch VW, Parekh KR, Leon L, Venkatraman E, Bains MS, Downey RJ, Boland P, Bilsky M, Ginsberg RJ: Factors determining outcome after surgical resection of T3 and T4 lung cancers of the superior sulcus. J Thorac Cardiovasc Surg 2000, 119:1147-1153.
• [16]Tamura M, Hoda MA, Klepetko W: Current treatment paradigms of superior sulcus tumours. Eur J Cardiothorac Surg 2009, 36:747-753.
• [17]Peedell C, Dunning J, Bapusamy A: Is there a standard of care for the radical management of non-small cell lung cancer involving the apical chest wall. Clin Oncol 2010, 22:334-346.
• [18]Rusch VW, Giroux DJ, Kraut MJ, Crowley J, Hazuka M, Winton T, Johnson DH, Shulman L, Shepherd F, Deschamps C, Livingston RB, Gandara D: Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Clin Oncol 2007, 25:313-318.