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The Annals of Thoracic Surgery, Vol 49, 391-398, Copyright © 1990 by The Society of Thoracic Surgeons
RC Read, G Yoder and RC Schaeffer
Two hundred forty-four veterans, with a mean age of 62.4 years, mainly
asymptomatic (pulmonary), were admitted generally for other disease or
pension evaluation and underwent lobectomy (131), segmentectomy (107), or
wedge resection (6) for T1 N0 M0 lung cancer between 1966 and 1988.
Conservative resection was preferred during the past decade. The average
lesion diameter was 2 cm. Thirty-day mortality was 2.9%, similar for the
three procedures. Absolute 5-year survival, 51%, was 78% if only deaths
from the initial lesion are considered; 19% died of comorbidity, and 8%
died of second lung cancers. Routine preoperative computed tomographic
staging and intraoperative sampling of even normal- sized hilar and
mediastinal nodes, conducted after 1982, improved survival (p less than
0.006). Patients with lesions less than 2 cm in diameter (146) did better
(p less than 0.04), and those with squamous tumors improved similarly (p
less than 0.02). Lesions that communicated with a bronchus (88) were more
malignant than those (156) that did not (p less than 0.02), because from
that locus undifferentiated nonsquamous tumors metastasized widely. These
results suggest that the T1 N0 M0 category is not uniform. Histology, size,
and location in the lung are significant variables. Results of conservative
resection were similar or better than those of lobectomy. The latter was
used more in deep-seated lesions, however, when major intersegmental planes
were transgressed, and before modern preoperative and intraoperative
staging. The T1 N0 M0 category should include lesions 2 cm or less in
diameter as a discrete entity.
ARTICLES
Survival after conservative resection for T1 N0 M0 non-small cell lung cancer
Surgical Service, John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas.
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