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Less than lobar resections for bronchogenic carcinoma
D Weissberg1, C J Straehley, N M Scully
1Tel Aviv University Sackler School of Medicine, E. Wolfson Medical Center, Holon, Israel.
Scandinavian Journal of Thoracic and Cardiovascular Surgery
|January 1, 1993
Summary
Less than lobar resections are effective for peripheral Stage I lung cancer, especially in high-risk patients. This approach offers promising long-term survival and manages secondary lung cancers effectively.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Peripheral clinical Stage I primary lung cancers often present challenges for surgical management.
- Many patients with early-stage lung cancer are considered poor surgical risks due to comorbidities or reduced lung function (e.g., FEV1 < 1 liter).
Purpose of the Study:
- To evaluate the long-term outcomes of sublobar resections for peripheral clinical Stage I non-small cell lung cancer (NSCLC).
- To assess the safety, efficacy, and survival rates associated with less than lobar resections in a cohort of high-risk patients.
Main Methods:
- A retrospective analysis of 170 patients undergoing sublobar resections (segmentectomies or wedge resections) for peripheral Stage I lung cancer between 1973 and 1987.
- Data collection included patient demographics, surgical procedures, postoperative outcomes, survival status, recurrence rates, and incidence of second primary lung cancers.
Main Results:
- The study reported a low hospital mortality rate of 3.5% (6 deaths).
- A 5-year disease-free survival rate of 54.7% was achieved (73 patients alive and cancer-free at 5-11 years, plus 20 who died from unrelated causes after 5 years).
- The incidence of synchronous or metachronous second primary lung cancers was 13.5%, with nine long-term survivors among them. Local recurrences occurred in 14.1% of patients.
Conclusions:
- Sublobar resection is a viable and effective treatment option for peripheral Stage I lung cancer, particularly in patients with poor prognostic factors.
- The promising long-term cancer-free survival and the significant rate of second primary lung cancers support the use of less than lobar resections in selected patients.