Results of the Surgical Resection for Lung Cancer Invading the Base of the Pulmonary Vein or the Left Atrium

  • Yoshimura Hirokuni
    Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine
  • Shinada Jun
    Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine
  • Koh Takamasa
    Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine
  • Abe Yoshiaki
    Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine
  • Ishihara Akira
    Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine
  • Kameya Tohru
    Department of Pathology, Kitasato University School of Medicine
  • Hirai Saburoh
    Department of Pulmonary Surgery, Kantoh Teishin Hospital
  • Kasai Kiyoshi
    Department of Pathology, Sapporo Medical College

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A retrospective analysis was done on 19 patients with squamous cell carcinoma of the lung invading the base of the pulmonary vein or the left atrial wall. The average patient's age was 58 years, and all of them were male. There were 10 N_1 and 9 N_2 diseases. 18 of the patients were M_0. The extent of the tumor invasion to the left atrium was classified into 5 grades according to the pathological findings of the resected specimens. Grade I: Invasion confined to the mediastinal fat tissue, Grade II: Invasion confined to the portion of the extrapericardial portion of the pulmonary vein, Grade III: Invasion confined to the portion of the pricardial reflection of the pulmonary vein or intrapericardial portion of the pulmonary vein, Grade IV: Invasion extending to the muscle layer of the left atrium, Grade V: Invasion protruding polypoid into the left atrial cavity. Two tumors were defined as Grade I, 3 were Grade II, 8 were Grade III, 3 were Grade IV and 3 were Grade V. The 5 year survival rate of all 19 patients was 31.6%. The survival of 6 patients for whom more than 2 mediastinal organs were resected with the lung was significantly inferior to that of 13 patients for whom only the left atrial wall was resected with the lung, 0% at 2 years vs. 46.2% at 5 years. Among the latter 13 patients, 5 patients with Grade I or II tumors showed a significantly higher percentage of survival than 8 patients with Grade III, IV or V tumors, 80% vs. 25% at 5 years. The survival of the patients with N_1 disease tended to be better than those with N_2 disease. The left atrial wall resection for patients with squamous cell carcinoam would be justifiable if the other mediastinal organ from the left atrium was free from tumor invasion.

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  • 北里医学

    北里医学 23 (6), 431-439, 1993-12-31

    北里大学

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