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Citak N.,Kars State Hospital | Buyukkale S.,Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital | Sayar A.,Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital | Metin M.,Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital | And 2 more authors.
Acta Chirurgica Belgica | Year: 2014

Background: Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial. Methods: Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor nodules group (n = 13) and the mediastinal fat group (n = 9). Results: Overall mortality and morbidity were 12.9% (n = 9) and 35.7% (n = 25), respectively and there was no significant differences between the four groups (p = 0.961, p = 0.750). Complete resection was possible in 47 patients (67.1%). The pathological nodal status was as follows: N0/1 in 58 patients and N2 in 12 patients. Five-year survival rate was 28.9% for all patients and 49.6%, 18.5%, 0% and 20.5% in the carinal, large vessels, mediastinal fat and separate tumor nodule groups, respectively. The carinal group was significantly different from the other groups in terms of survival (p = 0.05). By multivariate analysis, only two factors significantly and independently influenced survival: nodal status (N0/N1 versus N2 ; p = 0.01) and complete resection (R0 versus R1 ; p = 0.06). Conclusion: Resection is not a suitable approach for T4 NSCLC patients with N2 disease or incomplete resection. Resectable T4 NSCLC patients with carinal or tracheal involvement have better survival than do other T4 sub-groups. © Acta Chirurgica Belgica. Source


Citak N.,Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital | Sayar A.,Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital | Metin M.,Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital | Buyukkale S.,Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital | And 4 more authors.
Thoracic and Cardiovascular Surgeon | Year: 2015

Introduction: We investigated the prognostic effect of lymph nodes metastasis in aortopulmonary (AP) zone in resected non-small cell lung cancer of the left upper lobe (LUL). Methods:Between 1998 and 2010, 181 patients with LUL carcinoma underwent complete resection and were retrospectively analyzed. The patients were divided into four groups according to N status: N0 (n=68, 37.6%), N1 (n=64, 35.3%), N25,6+ (only metastasized to stations 5 and/or 6, n=36, 19.9%), and N27+ (only metastasized to stations 7, n=13, 7.2%). N1 were divided according to single and multiple (N1single n=49, N1multiple n=15) or peripheral and hilar (N1peripheral n=39, N1hilar n=25). Results:Overall 5-year survival rate was 55.1%. Five-year survivals were 76.1% for N0, 54.3% for N1, and 20.7% for N2. N1peripheral had a better survival than N1hilar (60.3 vs. 29.4%, p=0.09). Five-year survival of N1single was 60.1%, whereas it was 36.6% for N1multiple (p=0.02). Five-year survival rate was 24.6% for N25,6+. Skip metastasis for lymph nodes in AP zone (n=13) was a factor of better prognosis as compared to nonskip metastasis (n=23) (29.9 vs. 19.2%). There was no statistically significant difference between the N25,6+ and N1hilar (p=0.772), although N1peripheral had a significantly better survival than N25,6+ (p=0.02). AP zone metastases alone had a significantly worse survival than N1single (p=0.008), whereas there was no statistically significant difference between the N1multiple and N25,6+ (p=0.248). N27+ was not expected to survive 3 years after operation. They had a significantly worse prognosis than N25,6+ (p=0.02). Conclusion LUL tumors with metastasis in the AP zone lymph nodes, especially skip metastasis, were associated with a more favorable prognosis than other mediastinal lymph nodes. However, the therapy of choice for lung cancer with N25,6+ has not been clarified yet. © 2015 Georg Thieme Verlag KG Stuttgart. New York. Source

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