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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
Iwazaki M., Inoue H.
Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
Aim. Aim of this study was to analyze the efficacy of the multidisciplinary approach to lung cancer cases requiring surgical treatment.
Methods. At our facility, the following three major strategies have been applied to the treatment of lung cancer for the past 26 years: 1) surgical treatment of lung cancer involves lobectomy plus hilar mediastinal lymph node dissection, irrespective of the clinical stage of the tumor; 2) chemotherapy is administered after surgery, irrespective of tumor stage, and is continued on an outpatient care basis after discharge of the patient from the hospital; and 3) postoperative radiotherapy is applied to cases histologically found to have mediastinal lymph node metastasis. Although we were ready to modify these strategies if they were found to be unreliable, there was no necessity to modify any of these strategies to date. So far as the operative procedure is concerned, from 25 years on, surgery has been performed during artificial collapse of the lung on the thoracotomized side (surgery under separate lung ventilation), primarily using a Univent. This procedure markedly shortened the operative time. For 13 years, the Two Windows method under thoracoscopic guidance, a technique developed at our university, has been applied primarily to lung cancer cases at clinical stage IA.
Results. When cases followed for five years or more after surgery were analyzed, the five-year survival rate was 94% for stage IA cases, 87.5% for stage IB, 85.7% for stage IIA, 50.0% for stage IIB, 69.6% for stage IIIA, 16.7% for stage IIIB and 33.3% for stage IV.
Conclusion. The favorable results owe much to the team approach in which the performance of a therapeutic approach is monitored on the basis of a consistent basic treatment strategy. Still, further studies are necessary to confirm the efficacy of the multidisciplinary approach.