Key result
Incomplete resection linked to ~350% higher mortality in NSCLC with left atrial invasion.
Why the study?
Surgical outcomes of left atrial resection for NSCLC with left atrial invasion vary and require evaluation in selected patients.
Cohort (n=41)
No
Hazard Ratio: 4.46 (95% CI 1.42–14)
p-value: p=0.010
In selected patients with non-small cell lung cancer invading the left atrium, surgical resection is feasible and offers a median survival of 2.11 years, though outcomes are significantly worse with N2 nodal disease or incomplete resection.
May warrant prioritizing complete resection and N2-negative patients for surgery; leaves open prospective trials to confirm survival benefits.
Background: Left atrial invasion is classified as T4 non-small cell lung cancer (NSCLC). Surgical outcomes vary in selected patients. This study presents outcomes of left atrial resection at our center. Methods: Between August 2008 and May 2022, surgical outcomes of 41 NSCLC patients with left atrial invasion were retrospectively analyzed. Demographics, tumor characteristics, surgical procedures (pneumonectomy, lobectomy), nodal status (N0, N1, N2), and margin status (complete [R0], incomplete [R1]) were recorded. In-hospital mortality, morbidity, and long-term survival were evaluated. Cox proportional hazards regression model was used to assess all-cause mortality. Results: Mean age was 61.8 (±11.6) years, and 90.2% of patients were male. Median tumor diameter was 4.5 cm (interquartile range, 3.5-5.5 cm), 53.7% of tumors were right-sided. Squamous cell carcinoma was the predominant subtype (78%). Pathological nodal status was N0 in 25 patients and N1/N2 in 8 patients each. Complete resection was achieved in 35 patients (85.4%). In-hospital mortality was 4.8%, and long-term mortality was 70.8%. Median overall survival was 2.11 years (95% confidence interval [CI], 1.17-3.05). Multivariate Cox regression analysis identified N2 disease and incomplete (R1) resection as independent predictors of poor survival (N2: hazard ratio [HR], 3.7; 95% CI, 1.22-11.19; p=0.021; incomplete R1 resection: HR, 4.46; 95% CI, 1.42-14; p=0.010). Age (≥65 vs. <65), smoking, tumor size, side of surgery and neoadjuvant therapy were not significant in either univariate or multivariate analyses (all p>0.05). Conclusion: In NSCLC with left atrial invasion, surgery is feasible in selected patients, and long-term survival depends on excluding N2 disease and achieving complete resection.
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Kosif et al. (2026) conducted a cohort in Non-small cell lung cancer with left atrial invasion (n=41). Incomplete (R1) surgical resection vs. Complete (R0) surgical resection was evaluated on All-cause mortality (HR 4.46, 95% CI 1.42-14.00, p=0.010). In patients with non-small cell lung cancer and left atrial invasion, incomplete surgical resection (HR 4.46) and N2 disease (HR 3.7) were independent predictors of increased all-cause mortality.