Accurate Diagnosis of Aortic Invasion in Patients with Lung Cancer

Abstract

Background: The information regarding the optimal treatment of locally advanced lung tumor for achieving a cure remains limited. This is particularly true for an accurate diagnosis of tumor invasion of adjacent structures, especially the aorta.

Patients and methods: Between June 2014 and January 2016, 505 consecutive patients with chest disease underwent surgery at our Institution. Among these patients, five (1.0%) with lung tumor were strongly suspected of having aortic invasion. Their clinical records were retrospectively reviewed to identify factors to accurately diagnose aortic invasion in patients with lung cancer. The data on patient characteristics including modern-era clinical imaging, surgical details, and perioperative outcomes were analyzed.

Results: The study population comprised of four males and one female. The histological types were non-small cell carcinoma lung cancer in four cases and metastatic carcinoma from renal cell carcinoma in one. No cases were determined to be negative by both computed tomography and magnetic resonance imaging. However, an intraoperative assessment showed the resectability of lesions without invasion in all cases.

Conclusion: The diagnosis of aortic invasion may be overestimated, although aortic invasion is considered an absolute contraindication to surgical management with radical intent. Physicians should pay attention to the possibility of aortic invasion, even if the angle in contact with the tumor indicates a wide field of view, in order to provide a chance for a cure.

Keywords: Aortic invasion; lung cancer; surgery.