TITLE

Is the initial feasibility of lobectomy for stage I non-small cell lung cancer in severe heterogeneous emphysema justified by long-term survival?

AUTHOR(S)
Martin-Ucar, Antonio E.; Fareed, Khaleel R.; Nakas, Apostolos; Vaughan, Paul; Edwards, John G.; Waller, David A.
PUB. DATE
July 2007
SOURCE
Thorax;Jul2007, Vol. 62 Issue 7, p577
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The feasibility of anatomical lobectomy in patients with bronchial carcinoma in an area of severe heterogeneous emphysema whose respiratory reserve is outside operability guidelines has previously been confirmed. A review was undertaken to determine whether this approach is justified by long-term survival. Methods: A single surgeon's 8 year experience of 118 consecutive patients (74 men) of median age 70 years (range 45-84) who underwent upper lobectomy for pathological stage I non-small cell lung cancer (NSCLC) was reviewed. The preoperative characteristics, perioperative course and survival of the 27 cases with severe heterogeneous emphysema of apical distribution and a predicted postoperative forced expiratory volume in 1 s (ppoFEV1) of <40% (lobarLVRS group) were compared with the remaining 91 cases with a ppoFEV1 of >40% (control group). Results: Postoperative mortality was 1 of 27 in the lobarLVRS group and 2 of 91 in the control group (p = NS). Five-year survival in the lobarLVRS group was 35% compared with 65% in the control group without concomitant severe emphysema (p = 0.001), although rates of tumour recurrence were similar. Conclusions: Long-term survival after lobarLVRS for stage I lung cancer is limited by physiological rather than oncological factors. However, outcomes are still better than those reported for any other modality of treatment in this group of high-risk patients. This finding justifies the decision to offer lobectomy in these selected cases.
ACCESSION #
25757865

 

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