Local recurrence of resectable non-oat cell carcinoma of the lung. A warning against conservative treatment for N0 and N1 disease.

Ninety-five patients with non-oat cell lung cancer underwent resection of all apparent disease and were followed for a minimum of 36 months. Incidence of recurrence was 34% in 47 patients with N0 disease, 65% in 32 patients with N1 disease, and 81.3% in 16 patients with N2 disease (P less than 0.02 and P less than 0.005, respectively). Seventy-five percent of the recurrences with N0 disease were local, compared with 28.6% with N1 disease (P less than 0.01) and 15.6% with N2 disease (P less than 0.005). Presumably some of the patients with N0 disease could have been cured by eradication of local disease with a pneumonectomy. Patients with N1 disease had a greater rate of local recurrence when treated with lobectomy compared with pneumonectomy, and as with N0 patients, some could have been cured by eradication of local disease with the more extensive procedure. Patients with N2 disease were more apt to have distant before local recurrence, which obviates the benefits of a more extensive resection. The incidence of distal recurrence was statistically greater in N1 than in N0 disease (P less than 0.001) and similar between N1 and N2 disease. It was concluded that, when N0 and N1 disease is present, a more extensive procedure should be considered, even though it appears that all disease would be removed by a conservative resection.