Pneumonectomy in stage IIIA lung cancer: when expansion doesn’t mean better?
Aim - to analyze the short-term and long-term outcomes of pneumonectomies and lobectomies with an angioplastic component performed in stage III lung cancer. Material and methods. From 2009 to 2016, 46 patients with stage IIIa non-small cell lung cancer (38 men and 8 women, average age 54,2±6,4 years) underwent surgery. Angioplastic lobectomies were performed in 22 cases, and pneumonectomy was performed in 24 cases. Results. The incidence of complications after angioplastic lobectomies (APL) was 22,7% (5 cases), after pneumonectomies (PE) - 33,3% (8 cases). Mortality was 2 (9,1%) cases after APL, 4 (16,8%) patients died after PE. The indicators of 1, 3 and 5-year cumulative survival, as well as the median survival in both groups for stage III lung cancer were 90,9%, 57,2%, 34,8%, 38,5 months for patients who have undergone angioplastic lobectomy and 83,3%, 50,5%, 14,7%, 36 months for patients who have undergone pneumonectomy, respectively. When analyzing the causes of death of patients in the pneumonectomy group, 3 patients (12,5%) died from decompensation of comorbid pathology. There were no such patients in the organ-sparing treatment group (p=0,02). The indicators of 1, 3 and 5-year relapse-free survival, as well as the median relapse-free survival in both groups at stage III lung cancer were 80%, 52%, 44,6%, 33,3 months for patients who have undergone APL and 80%, 42,1%, 22,5%, 33,7 months for patients who have undergone PE, respectively. Conclusion. An increase in the volume of the removed lung parenchyma before pneumonectomy at advanced stages of the disease does not increase the radicality of the intervention, as evidenced by the indicators of overall and relapse-free survival. In addition, when performing a pneumonectomy, there is a potential risk of the patient falling out of the adjuvant treatment protocol, due to the higher frequency of postoperative complications. It is necessary to strive to perform parenchymal-sparing interventions at any stage of the tumor process.