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Ann Thorac Surg 1976;21:371-377
© 1976 The Society of Thoracic Surgeons
From the Department of Surgery, Section of Thoracic Surgery, The University of Michigan Medical Center, Ann Arbor, MI.
Accepted for publication September 30, 1975.
* Address reprint requests to Dr. Kirsh, C-7175 University Hospital, Ann Arbor, MI 48109.
Mediastinal lymph node dissection in conjunction with pulmonary resection was performed on 437 patients with bronchogenic carcinoma at the University of Michigan Medical Center from 1959 to 1969.
The absolute five- and ten-year survival rates for patients undergoing curative resection were 36.2 and 14.4%, respectively. The five-year survival of those without nodal metastases was 49.3%, and it was 31.1% in patients with hilar metastases only. The five-year survival of patients with mediastinal metastases who received radiation therapy was 23.1%.
Of the 193 patients with squamous cell carcinoma, 43% lived five years free from disease. The five-year survival of patients undergoing resection who had no hilar lymph node metastases was 53%, and it was 47.5% in those with hilar metastases only. The five-year survival in patients with mediastinal metastases who received postoperative irradiation was 34.4%.
Of 127 patients with adenocarcinoma, 27.5% lived five years free from disease and 14% for ten years. The five-year survival of those patients undergoing resection who had no lymph node metastases was 44%, whereas none of the patients with hilar metastases lived and only 4 of 34 patients (11.8%) with mediastinal metastases survived five years free of disease.
The findings suggest that histological cell type is an important factor in determining the prognosis in bronchogenic carcinoma, especially if there is evidence of lymph node involvement. In addition, this study suggests that it is the presence, and not necessarily the extent, of lymph node metastases in patients with squamous cell carcinoma that determines the survival rate following pulmonary resection, provided that those patients with mediastinal involvement undergo postoperative mediastinal irradiation.
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