Recurrence at the bronchial stump after resection of lung cancer

Recurrence at the bronchial stump frequently is difficult to diagnose before the disease progresses. Patients with recurrence at the bronchial stump after surgical treatment were studied to clarify characteristics.

Reports on this type of recurrence are few.

Between January 1979 and December 1988, 625 primary lung cancers were resected. Fourteen patients (2.2%), in whom recurrence occurred at the bronchial stump, were studied pathologically and clinically.

Eight tumors (57.1%) were squamous cell carcinomas, five (35.7%) were adenocarcinomas, and one (7.1%) was small cell carcinoma. Pathologically, six tumors (42.9%) were stage I, four (28.6%) were stage II, two (14.3%) were stage IIIA, and two (14.3%) were stage IV. Eight patients had bloody sputum at recurrence; two cases were asymptomatic. Submucosal tumors were observed bronchoscopically at recurrence in 11 patients. Considering lymphadenopathy on chest x-ray, the submucosal type recurrence may have been direct invasion from metastatic lymph nodes. The periods from the operation to the recurrence were 7 to 102 months (mean 28.8 months). In 8 of 14 patients, recurrence was observed within 24 months. All but one patient died within 24 months of recurrence detection.

Long survival could be expected only if there were no metastases in the mediastinal lymph nodes. If the tumors were detected earlier, it was possible to cure the tumors by intensive therapy, even in submucosal type recurrence. Regular bronchoscopic examination is needed to diagnose the recurrence at the bronchial stump as early as possible.