The purpose of this study was to determine whether en bloc resection of non-small cell lung cancer (NSCLC) invading the thoracic inlet (TI) and spine can provide good long-term outcomes.

We studied 54 consecutive patients treated with en bloc resection of NSCLC invading the TI and spine between 1992 and 2009 at our center. There were 36 men and 18 women with a mean age of 51 years (range, 37 to 71 years). Tumor resection involved at least 2 vertebral levels. We divided the patients into 3 groups based on whether vertebral invasion involved the transverse process only, the intervertebral foramina, requiring hemivertebrectomies with spinal fixation, or the vertebral body, requiring total vertebral body resection with spinal fixation.

Induction chemotherapy was given to 27 (50%) patients including 3 who also received induction radiotherapy. Nine (17%) patients were in the transverse process group, 42 (78%) in the intervertebral foramina group, and 3 (6%) in the vertebral body group. Resection involved the subclavian artery in 19 (35%) patients. Complete resection was achieved in 49 (91%) patients. There were no perioperative deaths or residual neurologic impairments. Recurrence occurred in 31 (57%) patients and was local (n = 6), systemic (n = 24), or both (n = 1). Local recurrence was more common in patients with N2-3 disease (p = 0.0008) and subclavian artery involvement (p = 0.031). There was a nonsignificant increase in local recurrence in patients with positive resection margins (40% vs 10%, p = 0.058). The 1-, 5-, and 10-year survival rates were 82%, 31%, and 31%, respectively. The 1-, 5- and 10-year disease-free survival rates were 63%, 28%, and 28%, respectively. Five patients are alive and free of disease 10 years after surgery. By multivariate analysis, factors that independently affected survival were incomplete (R1) resection (p = 0.006; odds ratio 67; 95% confidence interval 1.5 to 11.3) and subclavian artery involvement (p = 0.037; odds ratio 0.46; 95% confidence interval 0.2 to 0.9).

Good long-term survival can be achieved in highly selected patients with NSCLC invading the TI and spine, provided complete en bloc resection is performed.

The objective of the present study was to evaluate the utility of B-type natriuretic peptide for prediction of postoperative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer.

A prospective observational study was performed involving 80 consecutive patients aged 75 years or older who underwent a scheduled pulmonary resection for lung cancer in two specialized thoracic centers between January 2008 and June 2010. Baseline clinical details were obtained, and spirometry and examination of serum B-type natriuretic peptide levels were performed before surgery. The primary endpoint was the incidence of postoperative cardiopulmonary complications.

Postoperative cardiopulmonary complications were identified in 34 (43%) patients; these patients had significantly higher preoperative B-type natriuretic peptide levels than those without cardiopulmonary complications (84.0 ± 93.7 pg/mL vs 22.0 ± 18.2 pg/mL; p < 0.0001). The area under the receiver operating characteristic curve for B-type natriuretic peptide to predict postoperative cardiopulmonary complications after pulmonary resection for lung cancer was 0.85 (95% confidence interval 0.76 to 0.94; p < 0.0001). A B-type natriuretic peptide value of 30 pg/mL had a sensitivity of 79% and a specificity of 83% for predicting postoperative cardiopulmonary complications after pulmonary resection for lung cancer. The incidences of both cardiovascular and respiratory complications were significantly higher in patients with preoperative B-type natriuretic peptide levels of 30 pg/mL or more.

Preoperative B-type natriuretic peptide level could be a useful predictor of postoperative cardiopulmonary complications in elderly patients after pulmonary resection for lung cancer.