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.
SEATTLE-The idea that limited resections in lung cancer necessarilyyield a poorer outcome does not hold up, says John P. GriffinMD, chief, Division of Pulmonary and Critical Care Medicine, Universityof Tennessee, Memphis, Health Science Center.
"People have been led to believe that patients wouldn't liveas long with the less extensive operations," Dr. Griffinsaid in an interview at the 1995 International Conference of theAmerican Thoracic Society and American Lung Association.
But his review of 130 patients treated surgically at the VeteransAffairs Medical Center-Memphis showed comparable survival curvesin patients who had a wedge resection or a single segment takenout of one lobe, and in those who had standard lobectomy or pneumonectomy.In each case, he said, "the surgeons thought they had removedall cancerous disease."
Dr. Griffin, who presented his data at a poster session, hopesthat this analysis will lead surgeons to regard only partial removalof a lobe as "an acceptable cancer operation." He saidthis was especially important in the VA patients, since most weresmokers and many did not have enough lung function left to permita lobectomy.
The patients came from a tumor registry of 744 consecutive, newlydiagnosed male lung cancer patients seen from 1988 through 1992at the VA hospital. Of this number, 157 were either too ill forsurgery or refused treatment.
Of the remainder, an intention to treat analysis showed that 22%(130) had surgical resection. Lobectomy was done in 61%, pneumonectomyin 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 andfree of disease at 1 year, and about half of this group are expectedto be alive and free of disease at 5 years.
The median survival rates are as follows: stage I disease, 37months; stage II, 18 months; stage IIIA, 11 months; and stageIIIB, 13 months.
The 16 patients with stage II disease are showing only about a30% survival rate at 3 years, Dr. Griffin said, compared withabout 50% for the stage I patients. No patients with more advanceddisease survived for more than 3 years.