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 (ppoFEV(1)) of <40% (lobarLVRS group) were compared with the remaining 91 cases with a ppoFEV(1) 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.
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 (ppoFEV(1)) of <40% (lobarLVRS group) were compared with the remaining 91 cases with a ppoFEV(1) 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.
Authors: Anna Maria Ciccone; Bryan F Meyers; Tracey J Guthrie; Gail E Davis; Roger D Yusen; Stephen S Lefrak; G Alexander Patterson; Joel D Cooper Journal: J Thorac Cardiovasc Surg Date: 2003-03 Impact factor: 5.209
Authors: Keith S Naunheim; Douglas E Wood; Zab Mohsenifar; Alice L Sternberg; Gerard J Criner; Malcolm M DeCamp; Claude C Deschamps; Fernando J Martinez; Frank C Sciurba; James Tonascia; Alfred P Fishman Journal: Ann Thorac Surg Date: 2006-08 Impact factor: 4.330
Authors: Alfred Fishman; Henry Fessler; Fernando Martinez; Robert J McKenna; Keith Naunheim; Steven Piantadosi; Gail Weinmann; Robert Wise Journal: N Engl J Med Date: 2001-10-11 Impact factor: 91.245
Authors: Chan Yeu Pu; Christine M Lusk; Christine Neslund-Dudas; Shirish Gadgeel; Ayman O Soubani; Ann G Schwartz Journal: JTO Clin Res Rep Date: 2022-07-04