SEATTLE-The idea that limited resections in lung cancer necessarily yield a poorer outcome does not hold up, says John P. Griffin MD, chief, Division of Pulmonary and Critical Care Medicine, University of Tennessee, Memphis, Health Science Center.
"People have been led to believe that patients wouldn't live as long with the less extensive operations," Dr. Griffin said in an interview at the 1995 International Conference of the American Thoracic Society and American Lung Association.
But his review of 130 patients treated surgically at the Veterans Affairs Medical Center-Memphis showed comparable survival curves in patients who had a wedge resection or a single segment taken out of one lobe, and in those who had standard lobectomy or pneumonectomy. In each case, he said, "the surgeons thought they had removed all cancerous disease."
Dr. Griffin, who presented his data at a poster session, hopes that this analysis will lead surgeons to regard only partial removal of a lobe as "an acceptable cancer operation." He said this was especially important in the VA patients, since most were smokers and many did not have enough lung function left to permit a lobectomy.
The patients came from a tumor registry of 744 consecutive, newly diagnosed male lung cancer patients seen from 1988 through 1992 at the VA hospital. Of this number, 157 were either too ill for surgery or refused treatment.
Of the remainder, an intention to treat analysis showed that 22% (130) had surgical resection. Lobectomy was done in 61%, pneumonectomy in 12%, and wedge resection or segmentectomy in 27%.
Of the 130 resected patients, 86 (66%) had stage I disease; 16 (12%), stage II disease; 20 (15%), stage IIIA disease; and 8 (6%), stage IIIB disease. Of these patients, 98 (75%) were alive and free of disease at 1 year, and about half of this group are expected to be alive and free of disease at 5 years.
Median Survival Rates
The median survival rates are as follows: stage I disease, 37 months; stage II, 18 months; stage IIIA, 11 months; and stage IIIB, 13 months.
The 16 patients with stage II disease are showing only about a 30% survival rate at 3 years, Dr. Griffin said, compared with about 50% for the stage I patients. No patients with more advanced disease survived for more than 3 years.