Surgical treatment of superior pulmonary sulcus (Pancoast) tumor invading spine

doi:10.3877/cma.j.issn.2095-8773.2022.03.04

Abstract

Abstract:

Superior pulmonary sulcus tumor, also known as Pancoast tumor, has long been a challenge in thoracic surgery, due to its difficulty in exposure and complexity in local anatomy. Pancoast tumor with spine invasion was once thought to be inoperable and was listed as a contraindication to surgery. More recently, with the development in surgical techniques and the establishment of multidisciplinary approaches, several specialized centers have claimed the achievement of en bloc R0 resection of Pancoast tumor with spine invasion, which was accomplished by vertebral resection and reconstruction in cooperation with neurosurgeons. Some patients survived a long time after surgery. On the other hand, the use of induction therapy extends resectability preoperatively, and hybrid surgery with the assistance of a thoracoscope would lead to less surgical trauma, showing a promising potential in morbidity control.

Key words: Superior pulmonary sulcus tumor, Pancoast tumor, Spine, Surgery, Prognosis

Qiuyuan Li, Kaiqi Jin, Gening Jiang. Surgical treatment of superior pulmonary sulcus (Pancoast) tumor invading spine[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2022, 09(03): 150-156.

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侵犯类型	侵犯范围	处理方式
A型	横突、椎间孔但未进入椎管、椎体完整	横突及神经根切除
B型	侵入椎管且累及≥1个神经根和≤1/2椎体	椎体半切除加后固定
C型	侵犯>1/2椎体，且至少累及1个节段	椎体全切加前后双侧固定

侵犯类型	侵犯范围	处理方式
A型	横突、椎间孔但未进入椎管、椎体完整	横突及神经根切除
B型	侵入椎管且累及≥1个神经根和≤1/2椎体	椎体半切除加后固定
C型	侵犯>1/2椎体，且至少累及1个节段	椎体全切加前后双侧固定

作者	年份	病例数	并发症率	中位生存期	生存率	预后因素
Gandhi等^[41]	1999	17	42%	25个月	2年：54%	R0切除
Grunenwald等^[32]	2002	19	53%	24个月	2年：53%；5年：14%	未分析
Bilsky等^[35]	2002	42	33%	1.44年	2年：43.8%；5年：26%	R0或R1切除
Bolton等^[36]	2009	39	28%	18个月	2年：47%；5年：27%	单因素：R0切除、淋巴结阳性；多因素：淋巴结阳性
Fadel等^[12]	2011	54	55%	24个月	5年：31%	多因素：R0切除、锁骨下动脉侵犯
Collaud等^[40]	2013	48	21%	未提供	3年：69%；5年：61%	单因素：病理缓解、R0切除和ICU住院天数；多因素：病理缓解

作者	年份	病例数	并发症率	中位生存期	生存率	预后因素
Gandhi等^[41]	1999	17	42%	25个月	2年：54%	R0切除
Grunenwald等^[32]	2002	19	53%	24个月	2年：53%；5年：14%	未分析
Bilsky等^[35]	2002	42	33%	1.44年	2年：43.8%；5年：26%	R0或R1切除
Bolton等^[36]	2009	39	28%	18个月	2年：47%；5年：27%	单因素：R0切除、淋巴结阳性；多因素：淋巴结阳性
Fadel等^[12]	2011	54	55%	24个月	5年：31%	多因素：R0切除、锁骨下动脉侵犯
Collaud等^[40]	2013	48	21%	未提供	3年：69%；5年：61%	单因素：病理缓解、R0切除和ICU住院天数；多因素：病理缓解

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