Approximately five percent of the lung cancers involve the chest wall and spine by direct extension and remain localized at the time of diagnosis. T4 lesions invading the vertebra are considered inoperable. We reviewed a new evolution in the surgical treatment of lung cancer involving the vertebra (T4N0M0) and reported preliminary results of our approach.
Four patients with T4N0M0 (vertebral involvement) lung cancer underwent en bloc surgical resection of tumor at the Uludag University Faculty of Medicine between 1998 and 2002. Posterior stabilization, hemilaminectomy and osteotomy of the involved vertebral bodies below the corresponding pedicle were performed in the prone position and then in lateral position en bloc resection were completed along with the lung resection (large wedge resection or lobectomy) and involved vertebral bodies.
Three of the patients died during the follow-up period at 6h, 8th and 14h postoperative months, respectively. The fourth patient is still in follow-up of 20 months.
Although T4N0M0 (vertebral involvement) lung cancers are considered inoperable, lung resection with hemivertebrectomy of the involved vertebra after neoadjuvant chemotherapy and radiotherapy is an alternative treatment in this type of lung cancers.
Keywords: Lung cancer, vertebral involvement, vertebral osteotomy, hemivertebrectomy, pulmonary resection.