초록접수 현황
| 15F-120 | 구연 발표 |
Surgical Resection for Lung Cancer in Patients with Coal Worker’s Pneumoconiosis
Kyung Soo Kim¹, Young Jo Sa², Young Kyu Moon¹, Sung Bo Sim², Jae Kil Park¹
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea¹, St. Mary's Hospital, Catholic Cancer Center, Catholic University Medical College, Seoul, Republic of Korea²
Background : Occupational exposure of coal dust and subsequent chronic inflammation are known as possible causes of lung cancer. However, the poor lung condition of lung due to fibrotic lung with anthracotic calcified nodes make surgeons to hesitate whether surgical resection is acceptable in patients with coal worker’s pneumoconiosis (CWP). The purpose of this study is to review our experience and to evaluate the surgical role for lung cancer in patients with CWP.
Methods : Between January 2000 and January 2015, total 27 CWP patients who underwent surgical resection with pathologically proven lung cancer were retrospectively reviewed. Patient demographic profile, tumor characteristics, surgical approach and clinical outcomes were analyzed.
Results : Mean age was 67 years (range, 43-81 years) with median follow-up of 40 months (range, 7-129 months). Mean occupational working period as a mine worker was 19.3 ± 7.7 years (range, 9-40 years). There were 16 (66.7%) smokers and 6 patients having a history of tuberculosis. There were 10 patients in ECOG 1 and 17 in ECOG 0. Mean FVC and FEV1 were 3.25L and 2.29L (FVC%: 95.9%; FEV1%: 90.2%; FEV1/FVC: 74.7%; DLCO: 71.9%), respectively. Induction chemotherapy was conducted in 6 (22.2%) patients achieving partial responses. There were 23 lobectomies (1 sleeve lobectomy), 1 pneumonectomy and 3 wedge resections. Thoracosocpic approach was performed in 13 patients with 8 (61.5%) thoracotomy conversions. The mean operation time was 185.5 ± 65.6 minutes (range, 60-295 minutes) and the estimated blood loss was 314.4 ± 232.1 ml (range, 30-600 ml). Tumor locations were 14 in right side and 13 in left side (RUL: 6, RML: 3, RLL: 5, LUL: 8, LLL: 5). The pathologic findings were 17 (62.9%) squamous cell carcinomas, 8 (29.6%) adenocarcinomas, 1 adenosquamous and 1 large cell carcinoma. The mean tumor size was 3.6 ± 1.6 cm (range, 0.5-7.0 cm). The pathologic staging revealed stage 0 (Tis) in 1 patient, stage I in 19 patients, stage II in 5 patients and stage III in 2 patients. The R0 resection was possible in all patients but adjuvant chemotherapy was applied in 8 patients (IB: 4; IIA: 3; IIB: 1). The mean hospital stay was 18.9 ± 21.1 days (range, 5-114 days). Complications were in patients with 4 postoperative bleeding without reoperation, 2 persistent air leakage and 2 with pneumonia but there was no operative mortalities. The recurrence was developed in 5 (18.5%) patients with distant metastasis. The 3 and 5 year disease-free survival rates were 66.3% and 53%; the 3 and 5 year overall-survival rate was 68.2% and 61.3%, respectively.
Conclusion : The patients with CWP revealed permeable pulmonary function for lobectomy and favorable results were achieved with low morbidities. We concluded that surgical resection for lung cancer in patients with CWP is reasonable treatment modality. However, surgeons should consider severe adhesive anthracotic lymph nodes and fibrotic stiff lung prior to surgery.
Methods : Between January 2000 and January 2015, total 27 CWP patients who underwent surgical resection with pathologically proven lung cancer were retrospectively reviewed. Patient demographic profile, tumor characteristics, surgical approach and clinical outcomes were analyzed.
Results : Mean age was 67 years (range, 43-81 years) with median follow-up of 40 months (range, 7-129 months). Mean occupational working period as a mine worker was 19.3 ± 7.7 years (range, 9-40 years). There were 16 (66.7%) smokers and 6 patients having a history of tuberculosis. There were 10 patients in ECOG 1 and 17 in ECOG 0. Mean FVC and FEV1 were 3.25L and 2.29L (FVC%: 95.9%; FEV1%: 90.2%; FEV1/FVC: 74.7%; DLCO: 71.9%), respectively. Induction chemotherapy was conducted in 6 (22.2%) patients achieving partial responses. There were 23 lobectomies (1 sleeve lobectomy), 1 pneumonectomy and 3 wedge resections. Thoracosocpic approach was performed in 13 patients with 8 (61.5%) thoracotomy conversions. The mean operation time was 185.5 ± 65.6 minutes (range, 60-295 minutes) and the estimated blood loss was 314.4 ± 232.1 ml (range, 30-600 ml). Tumor locations were 14 in right side and 13 in left side (RUL: 6, RML: 3, RLL: 5, LUL: 8, LLL: 5). The pathologic findings were 17 (62.9%) squamous cell carcinomas, 8 (29.6%) adenocarcinomas, 1 adenosquamous and 1 large cell carcinoma. The mean tumor size was 3.6 ± 1.6 cm (range, 0.5-7.0 cm). The pathologic staging revealed stage 0 (Tis) in 1 patient, stage I in 19 patients, stage II in 5 patients and stage III in 2 patients. The R0 resection was possible in all patients but adjuvant chemotherapy was applied in 8 patients (IB: 4; IIA: 3; IIB: 1). The mean hospital stay was 18.9 ± 21.1 days (range, 5-114 days). Complications were in patients with 4 postoperative bleeding without reoperation, 2 persistent air leakage and 2 with pneumonia but there was no operative mortalities. The recurrence was developed in 5 (18.5%) patients with distant metastasis. The 3 and 5 year disease-free survival rates were 66.3% and 53%; the 3 and 5 year overall-survival rate was 68.2% and 61.3%, respectively.
Conclusion : The patients with CWP revealed permeable pulmonary function for lobectomy and favorable results were achieved with low morbidities. We concluded that surgical resection for lung cancer in patients with CWP is reasonable treatment modality. However, surgeons should consider severe adhesive anthracotic lymph nodes and fibrotic stiff lung prior to surgery.
책임저자: Jae Kil Park
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
연락처 : Kyung Soo Kim, Tel: 02-2258-6139 , E-mail : cskks@catholic.ac.kr
