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Is the initial feasibility of lobectomy for stage I non- small cell lung cancer in severe heterogeneous emphysema justified by long-term survival?
  1. Antonio E Martin-Ucar (lungsout{at}yahoo.com)
  1. Glenfield hospital. Leicester, United Kingdom
    1. Fareed R Khaleel (kfareed{at}doctors.org.uk)
    1. Glenfield hospital. Leicester, United Kingdom
      1. Apostolos Nakas (drnakas{at}yahoo.co.uk)
      1. Glenfield hospital. Leicester, United Kingdom
        1. Paul Vaughan (paul.vaughan{at}astrazeneca.com)
        1. Glenfield hospital. Leicester, United Kingdom
          1. John G Edwards (yfy36{at}dial.pipex.com)
          1. Glenfield hospital. Leicester, United Kingdom
            1. David A Waller (david.waller{at}uhl-tr.nhs.uk)
            1. Glenfield hospital, Leicester, United Kingdom

              Abstract

              Background We have previously confirmed the feasibility of anatomical lobectomy in patients with bronchial carcinoma in an area of severe heterogeneous emphysema whose respiratory reserve is outside operability guidelines. We now reviewed our cumulative experience to determine whether this approach is justified by long- term survival.

              Methods We reviewed a single-surgeon's 8-year experience of 118 consecutive patients [74 male and 44 female, median age 70 (range 45 to 84) years] who underwent upper lobectomy for pathological stage I non-small-cell lung cancer (NSCLC). The pre-operative characteristics, perioperative course and survival of the 27 cases with severe heterogeneous emphysema of apical distribution and a predicted postoperative FEV1 (PpoFEV1) of less than 40% (lobarLVRS group) were compared to the remaining 91 cases with a PpoFEV1 greater than 40% (control group).

              Results Postoperative mortality were 1 of 27 after lobarLVRS and 2 of 91 in the control (p=ns). 5-year survival after lobar LVRS was 35% and in the control group without concomitant severe emphysema was 65% (p=0.001), although rates of tumour recurrence were similar.

              Discussion Long-term survival after lobar LVRS for stage I lung cancer is limited by physiological rather than oncological factors. However, outcomes are still better than reported for any other modality of treatment in this group of high risk patients. We feel justified in continuing to offer lobectomy in these selected cases

              • emphysema
              • lobectomy
              • non small cell lung cancer

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