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    Concomitant Chest Wall Resection and Reconstruction in a Cohort of 254 Patients of Non-small Cell Lung Cancer Resections Between 2007 and 2019: a 12-Year Experience from a Single Center in Turkey
    (Springer India, 2023) Batihan, Guntug; Ucvet, Ahmet; Yazgan, Serkan; Ceylan, Kenan Can; Gursoy, Soner; Kaya, Seyda Ors
    Lung cancer with chest wall invasion, which constitute 5-10% of operable non-small cell lung cancer cases, is heterogeneous in terms of factors that may affect the prognosis. We aim to share our experience including the surgical results of patients with non-small cell lung cancer (NSCLC) who underwent chest wall resection and identify the potential factors that may impact survival. The patients who underwent combined chest wall and lung resection due to primary lung cancer invading the chest wall in our center between 2007 and 2019 were reviewed. Variables such as age, tumor size, histological subtype, surgical technique, depth of invasion, the extent of resection, neoadjuvant, and adjuvant treatment status were examined. Two hundred fifty-four patients who underwent combined chest wall and lung resection were included in the study. There were 245 men and 9 women. The mean age was 61.0 SD8.4 years. The overall survival was 70.9 SD4.6 months, and the 5-year survival rate was 41.5 SD3.3%. In multivariate analyses, age, the extent of lung resection, the number of resected ribs, invasion depth, and completeness of chest wall resection were independent factors that have an effect on survival. This study shows that age, the extent of lung and chest wall resection, invasion depth, and completeness of chest wall resection are independent prognostic factors of survival in patients who underwent combined lung and chest wall resection for NSCLC. Institutional Review Board of the Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center (No: E-49109414-604.02.02).
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    Results of surgery after neoadjuvant treatment for non-small cell lung cancer
    (2024) Yagci, Tarik; Ucvet, Ahmet; Yazgan, Serkan; Samancilar, Ozgur; Gürsoy, Soner
    Background: In locally advanced non-small cell lung cancer, survival rates achieved only by surgical treatment are unfortunately lower than expected. It’s believed that survival rates can be raised by multimodal therapies including surgery. The purpose of the study is to analyse the results of surgical treatment in patients who underwent surgical resection after neoadjuvant treatment due to locally advanced non-small cell lung cancer. Materials and Methods: The patients who underwent lobectomy or pneumonectomy after neoadjuvant chemotherapy and/or radiotherapy due to locally advanced non-small cell lung cancer were included in this study. The patients were divided into two groups according to oncological treatment indication. Group A included patients who received neoadjuvant therapy due to T disease and group B due to N2 disease. The surgical interventions, pathological results, postoperative complications, mortality, recurrence, 5-year disease-free survival, and overall survival were analysed. Results: 154 patients were included in the study. 142 were men and 12 were women with a mean age of 57.7 ± 16.97 (between 35 and 77). Ninety-six patients received induction therapy due to T disease, and 58 patients due to N2 disease. Pneumonectomy was performed on 41 patients, lobectomy was performed on 113 patients (18 bronchial sleeve resection). Histopathologic results revealed squamous cell carcinoma in 96 (62.3%), adenocarcinoma in 52 (33.8) and large cell carcinoma in 6 (3.9%) patients. A complete response to neoadjuvant treatment was achieved in 19 (Group A, n = 15, group B, n = 4) patients. Postoperative pathologic results showed mediastinal lymph node metastasis in 13 (13.6%) patients in group A and, in 28 (48.3%) patients in group B, which is statistically significant. Prolonged air leak was the most common complication in both groups. Operative mortality was observed in 4 (2.6%) patients. In 82 patients 47 in group A and 35 in group B recurrence or metastasis were detected during the follow-up. 5-year disease-free survival rate was 43.2% in group A and 38.4% in group B. Five- year survival rate was 46.1% in group A and 38% in group B. Conclusions: The patients who achieved a histopathologic complete response following induction therapy had statistically significantly better disease-free and overall survival rates. Pathologically proven lymph node metastasis increased the rate of recurrence or metastasis significantly (p = 0.01). The disease-free and overall survival rate decreased significantly (p = 0.0001, p = 0.0001). It is deducible in light of these findings that patients who received neoadjuvant treatment for N2 achieved better disease-free survival and overall survival.