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The Journal of Cardiovascular Surgery 2002 February;43(1):103-8

language: English

Survival after bronchoplastic lobectomy for non small cell lung cancer compared with pneumonectomy according to nodal status

Ghiribelli C., Voltolini L., Luzzi L., Paladini P., Campione A., Gotti G.

From the Tho­racic Sur­gery ­Unit Depart­ment of Tho­racic and Car­di­o­vas­cular Sur­gery Uni­ver­sity Hos­pital of ­Siena, ­Siena, ­Italy


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Back­ground. In ­this ret­ro­spec­tive ­study we ­have com­pared the ­results ­after ­sleeve lobec­tomy and pneu­mo­nec­tomy per­formed for non ­small ­cell ­lung ­cancer in the ­period Jan­uary 1990-­December 1995 at the Tho­racic Sur­gery ­Unit, Uni­ver­sity Hos­pital of ­Siena. ­Follow-up was ­updated ­until ­December 2000.
­Methods. In ­that ­period, 38 ­patients under­went ­sleeve lobec­tomy and 127 under­went pneu­mo­nec­tomy. The bron­cho­plasty was a ­full ­sleeve in 30 ­patients and a bron­chial ­wedge resec­tion in ­eight. ­Systemic ­nodal dis­sec­tion was under­taken rou­tinely.
­Results. The 30-day post­op­er­a­tive mor­tality was 5.2% (2/38) in the ­sleeve lobec­tomy ­group and 3.9% (5/127) in the pneu­mo­nec­tomy ­group. Post­op­er­a­tive com­pli­ca­tions ­occurred in 23.6% of ­patients in the ­sleeve lobec­tomy ­group and in 23.2% of ­those in the pneu­mo­nec­tomy ­group. ­Local recur­rences ­occurred in 5.2% of ­patients in the ­sleeve lobec­tomy ­group and in 4.8% of ­those in the pneu­mo­nec­tomy ­group. The ­overall 5-­year sur­vival for the ­sleeve lobec­tomy ­group was 38% ­whereas ­that for the pneu­mo­nec­tomy ­group was 25% (p=0.03). ­Regarding ­lymph-­node involve­ment, in the ­sleeve lobec­tomy ­group, the 5-­year sur­vival for N0, N1 and N2 was 62.5, 17.5 and 12.5%, respec­tively.
Con­clu­sions. Our ­data con­firm ­that ­sleeve lobec­tomy, ­when per­formed in ­selected ­patients ­with non ­small ­cell ­lung ­cancer, pro­vides at ­least sim­ilar ­overall ­long ­term sur­vival to ­that ­seen ­after pneu­mo­nec­tomy. ­Long ­term ­result are ­chiefly ­related to ­nodal ­stage ­with a sig­nif­i­cantly ­lower sur­vival for ­patients ­with ­nodal involve­ment. As ­most ­patients ­with ­nodal involve­ment die ­from dis­tant metas­tases, adju­vant treat­ment, ­instead of ­type of resec­tion, ­would ­play a ­major ­role in pro­longing sur­vival.

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