P3.17-15 Therapeutic Outcome of Surgery for Superior Sulcus Tumor

Abstract

Treatment of superior sulcus tumor (SST) is challenging and often requires multidisciplinary approach. Accumulation of treatment outcome is a principal issue for the future. We retrospectively reviewed clinical records of the patients those who were clinically diagnosed to have SST which involved to the 1st rib but was resectable. From 2000 to 2017, 16 patients were eligible in our hospital. Average age of the patients was 62.3 (40-74). The number of the patients with various properties was following; men 16/ women 3, right lung 5/ left lung 11, squamous cell carcinoma 5/ adenocarcinoma 9/ pleomorphic carcinoma 1, induction chemoradiotherapy 12/ induction chemotherapy 3/ no induction treatment 1, and clinical stage T3N0M0 9/ T3N2M0 2/ T4N0M0 4/ T4N3M0 1. Pathological information and clinical information regarding recurrence and survival were collected. Correlation between prognosis and clinicopathological factors were statistically evaluated by both univariate and multivariate analysis. P value was regarded as statistically significant when it was less than 0.05. Undertaken surgical approach was posterolateral for 8 cases/ median sternotomy for 6 cases/ transmanubrial approach (TMA) + thoracoscopy for 2 cases. Combined resection extended to the 1st rib for 6 cases/ 2nd rib for 4 cases/ parietal pleura for 4 cases/ vessels for 4 cases. For curativity, pathological curative (R0) was achieved in 12 cases, while macroscopic curative (R1) was noted in 4 cases. Effect of induction treatment was revealed as Ef1 for 4 cases/ Ef2 for 7 cases/ Ef3 for 2 cases. There was no death within 30 days after surgery. Morbidity (grade3) occurred in 6. Postoperative recurrence was observed in 8 cases and 7 of them dead from lung cancer. 5-year survival rate was 48.8%. By multivariate analysis, R0 resection was a statistically significant factor which correlates with survival. R0 resection was a critical factor for postoperative survival. Thoracoscopic approach combined with TMA might contribute to reduce surgical invasiveness according to the location of the disease.