PANCOAST TUMOUR WITH SPINE RESECTION - CASE REPORT
Pancoast tumours are defined as tumours arising from the upper lobe and invading the thoracic inlet,representing less than 5% of all lung cancers. Clinical features depend on the involved structures. For many years invasion of the spine was considered unresectable and fatal. Due to the progress in spine surgery, en bloc resection including the spine is nowadays possible. We report the first case of a successful en bloc vertebral resection of a Pancoast tumour in a 66 year-old male, with a squamous cell carcinoma, treated at our department in a multidisciplinary setting, after induction chemoradiotherapy. An en bloc resection including the left upper lobe, the first three ribs and the vertebral body of D2, was performed through a Paulson incision after posterior cervico-dorsal arthrodesis. A complete R0 resection was confirmed on the pathology specimen. Currently, one year after surgery, although no local recurrence has occurred, the patient is being treated with immunotherapy due to disease progression in the right acetabulum which was irradiated (20Gy) and then submitted to iliac resection and prothesis reconstruction.
Panagopoulos et al.Pancoast tumors: characteristics and preoperative assessment. J Thorac Dis. 2014;6(S1):S108-S115.
Rush V. Management of Pancoast Tumours, The Lancet 2006; 7: 997-1005
Bolton et al. Superior sulcus tumors with vertebral body involvement: A multimodality approach. J Thorac Cardiovasc Surg. 2009;137:1379-87.
Fahed Zahiri et al. Single Posterior Approach for En-Bloc Resection and Stabilization for Locally Advanced Pancoast Tumors Involving the Spine: Single Centre Experience. Asian Spine J. 2016;10:1047-1057.
Collaudet al.En Bloc Resection of Pulmonary Sulcus Non-small Cell Lung Cancer Invading the Spine,A Systematic Literature Review and Pooled Data Analysis.Annals of Surgery 2015;262: 184-188.
Rush et al. Induction Chemoradiation and Surgical Resection for Superior Sulcus Non–Small-Cell Lung Carcinomas: Long-Term Results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160).J Clin Oncol. 2007, 25:313-318.
Grunenwaldet al. Radical en bloc resection for lung cancer invading the spine. J Thorac Cardiovasc Surg 2002;123:271-9.
Albertucciet al. Management of tumor adherent to the vertebral column. J Thorac Cardiovasc Surg. 1989;97:373–378.
Grunenwaldet al. Total vertebrectomy for en bloc resection of lung cancer invading the spine. Ann Thorac Surg. 1996;61:723–25.
Jain et al. Posterior midline approach for single-stage en bloc resection and circumferential spinal stabilization for locally advanced Pancoast tumors. J Neurosurg Spine 2008; 9:71–82.