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Ann Thorac Surg 2006;81:1013-1020
© 2006 The Society of Thoracic Surgeons
Accepted for publication June 24, 2005.
* Address correspondence to Dr Allen, Division of General Thoracic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Email: allen.mark{at}mayo.edu).
Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005. Winner of the J. Maxwell Chamberlain Memorial Award for General Thoracic Surgery.
BACKGROUND: Little prospective, multiinstitutional data exist regarding the morbidity and mortality after major pulmonary resections for lung cancer or whether a mediastinal lymph node dissection increases morbidity and mortality.
METHODS: Prospectively collected 30-day postoperative data was analyzed from 1,111 patients undergoing pulmonary resection who were enrolled from July 1999 to February 2004 in a randomized trial comparing lymph node sampling versus mediastinal lymph node dissection for early stage lung cancer.
RESULTS: Of the 1,111 patients randomized, 1,023 were included in the analysis. Median age was 68 years (range, 23 to 89 years); 52% were men. Lobectomy was performed in 766 (75%) and pneumonectomy in 42 (4%). Pathologic stage was IA in 424 (42%), IB in 418 (41%), IIA in 37 (4%), IIB in 97 (9%), and III in 45 (5%). Lymph node sampling was performed in 498 patients and lymph node dissection in 525. Operative mortality was 2.0% (10 of 498) for lymph node sampling and 0.76% (4 of 525) for lymph node dissection. Complications occurred in 38% of patients in each group. Lymph node dissection had a longer median operative time and greater total chest tube drainage (15 minutes, 121 mL, respectively). There was no difference in the median hospitalization, which was 6 days in each group (p = 0.404).
CONCLUSIONS: Complete mediastinal lymphadenectomy adds little morbidity to a pulmonary resection for lung cancer. These data from a current, multiinstitutional cohort of patients who underwent a major pulmonary resection constitute a new baseline with which to compare results in the future.
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W. Sienel, C. Stremmel, A. Kirschbaum, L. Hinterberger, E. Stoelben, J. Hasse, and B. Passlick Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localisation and width of resection margins -- implications for patient selection for segmentectomy Eur J Cardiothorac Surg, March 1, 2007; 31(3): 522 - 528. [Abstract] [Full Text] [PDF]
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G. M Wright, J-E C Holty, and M K Gould When in doubt should we cut it out? The role of surgery in non-small-cell lung cancer Thorax, February 1, 2007; 62(2): 190 - 191. [Full Text] [PDF]
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A. Brunelli, N. J. Morgan-Hughes, M. Refai, M. Salati, A. Sabbatini, and G. Rocco Risk-adjusted morbidity and mortality models to compare the performance of two units after major lung resections J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 88 - 96. [Abstract] [Full Text] [PDF]
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E. Belcher and P. Goldstraw Is radical mediastinal dissection mandatory for curative resection of NSCLC? Eur J Cardiothorac Surg, January 1, 2007; 31(1): 142 - 143. [Full Text] [PDF]
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S. Ganti, R. Milton, V. Anikin, and A. Thorpe Surgery for tumour recurrence in a pneumonectomy space Eur J Cardiothorac Surg, October 1, 2006; 30(4): 683 - 685. [Abstract] [Full Text] [PDF]
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F. Leo, P. Solli, G. Veronesi, D. Radice, A. Floridi, R. Gasparri, F. Petrella, A. Borri, D. Galetta, and L. Spaggiari Does chemotherapy increase the risk of respiratory complications after pneumonectomy? J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 519 - 523. [Abstract] [Full Text] [PDF]
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A. El-Sherif, W. E. Gooding, R. Santos, B. Pettiford, P. F. Ferson, H. C. Fernando, S. J. Urda, J. D. Luketich, and R. J. Landreneau Outcomes of Sublobar Resection Versus Lobectomy for Stage I Non-Small Cell Lung Cancer: A 13-Year Analysis Ann. Thorac. Surg., August 1, 2006; 82(2): 408 - 416. [Abstract] [Full Text] [PDF]
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J-E C Holty and M K Gould When in doubt should we cut it out? The role of surgery in non-small cell lung cancer. Thorax, July 1, 2006; 61(7): 554 - 556. [Full Text] [PDF]
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