P191. Resection of T4 Non-Small Cell Lung Cancer Invading the Spine: Short- and Long-term Outcomes of a Single-Institution
European Institute of Oncology
Milano, Turin
Italy - Contact Me
Dr. Galetta was born in Italy in 1971.
He is actually Chief of the Division of Thoracic Surgery of San Giovanni Bosco Hospital Turin, Italy since May 2024.
He degreed as M.D. in 1996 at Catholic University in Rome and there he complete his residency in Thoracic Surgery in 2002.
Previous experiences included a period at the Thoracic, Cardiac and Transplantation Dpt. of University of Nantes, France in 1998 (Prof. J.L. Michaud), and from 2001 to 2003 at Dpt, of Thoracic Surgery of the Institute Mutualiste Montsouris, Paris, France (Prof. D. Grunenwald).
He was degreed with the Diplome Inter-Universitaire de Chirurgie Thoracoscopique et Pneumologie Interventionnelle, Université René Descartes-Paris V,Paris, France in 2002.
Dr. Galetta has become Ph.D.in 2009 at the University of Bologna, Italy.
He worked as Senior Deputy Director at the Division of Thoracic Surgery at European Institut oof Oncology, Milan, Italy form May 204 to May 2024.
He was Assistant Professor at the University of Milan, Italy.
The main interests of Dr. Galetta are in thoracic surgical oncology (lung cancer, pleural disease, mediastinal disease, chest wall disease) and benign thoracic diseases.
Dr. Galetta participated to National and International Meetings as invited Speaker.
He is a Reviewer and Editor member for different Surgical and Oncological Journals.
He is author/co-author of 156 manuscript published on PUBMED, and of 15 Book Chapters.
Description
Surgical treatment of non-small cell lung cancer (NSCLC) invading the spine is controversial. We evaluated surgical results and long-term outcomes of patients with T4 NSCLC who underwent vertebral resection (VR) infiltrated by lung tumor.
Methods
Retrospective analysis of 18 consecutive patients undergoing VR for NSCLC invading the spine between 2003 and 2023 was performed. Eleven patients (61.1%) received induction therapy. Vertebral resection was divided into 5 types; type 1 (Figure 1, A): only transverse process; type 2A (Figure 1, B): transverse process with a portion of the vertebral body; type 2B (Figure 1, C) : a portion of vertebral body without transverse process; type 3 (Figure 1, D), hemivertebrectomy; type 4 (Figure 1, E): total vertebrectomy.
Results
There were 16 men with a median age of 62 years (range, 41-80). Ten patients (55.5%) had induction therapy. Vertebral resection included 4 type 1 resection, 7 type 2A, 4 type 2B, 2 type 3, and 1 type 4. Pneumonectomy was performed in 3 patients, lobectomy in 9, segmentectomy in 3 and wedge in 3. Complete resection was achieved in 16 patients (88.8%). Surgical nodal status was N0 in 11 patients, N1 in 4, and N2 in 3, each. There was no postoperative mortality. Morbidity was observed in 7 patients (38.9%), including 1 (5.5%) neurologic complication, 3 (16.7%) ARDS, and 3 (16.7%) cardiac. Eight patients (44.4%) are alive without disease after e mean follow up of 48.6 months. The 1- and 5-year predicted survivals were 79% and 40.4%, respectively. Patients without nodal involvement had the best prognosis (56.3% vs 0%; p=0.0009). Induction therapy did not influence survival and morbidity.
Conclusions
Resection of NSCLC with vertebrectomy is technically demanding and is associated with acceptable morbidity. However, an encouraging long-term survival observed in this series suggest that resection could be a valid option in selected patients with vertebral invasion by NSCLC.
Authors
Domenico Galetta (1), Lorenzo Spaggiari (2)
Institutions
(1) Division of Thoracic Surgery, San Giovanni Bosco Hospital, Turin, Italy, (2) European Institute of Oncology, Milan, Lombardia