Original Articles
“Incomplete Resection” in Non–Small Cell Lung Cancer: Need for a New Definition

https://doi.org/10.1016/S0003-4975(97)01190-9Get rights and content

Abstract

Background. This study was designed to determine the prognostic value of positive surgical resection margin or highest nodal station sampled at thoracotomy in patients with non–small cell lung cancer.

Methods. Two reviewers independently examined the surgical records and pathologic reports from a randomized trial comparing computed tomography versus mediastinoscopy for staging of lung cancer. They recorded pathologic findings at the surgical resection margin, the highest mediastinal nodal station sampled at thoracotomy, histologic type, tumor size, N status, and evidence of vascular or lymphatic invasion. These variables formed the independent variables in logistic regression models to predict recurrence.

Results. Except for 1 patient, follow-up at 3 years for 399 included patients was complete. Significant predictors of recurrence were tumor size (odds ratio [OR], 1.2 (per centimeter); 99% CI [confidence interval], 1.1 to 1.4), and N status (compared with N0, N1: OR, 1.6; CI, 0.8 to 3.1; N2: OR, 3.2; CI, 1.4 to 7.5). Other variables, including positive surgical resection margin, did not predict early recurrence or death.

Conclusions. In patients with non–small cell lung cancer, surgical resection margin or highest nodal station sampled at thoracotomy that are involved by carcinoma do not predict recurrence. The current definition of incomplete resection has limited prognostic significance.

Section snippets

Setting

We reviewed the records of patients presenting with apparently operable carcinoma of the lung who participated in a Canadian multicenter trial that enrolled 685 patients from November 1987 to September 1990 and followed up each patient for 3 years. Participating patients who had undergone a thoracotomy form the present study group. The primary results of this trial have been reported elsewhere [11].

Data Extraction

Two investigators independently reviewed the surgical record and pathologic reports of each

Study Population

Of the 685 patients randomized to either computed tomography or mediastinoscopy, 483 ultimately had a thoracotomy. Two-hundred two randomized patients did not have a thoracotomy for the following reasons [11]: 147 were deemed inoperable after the initial investigation, 8 declined operation, 18 had a medical contraindication to the operation, and 29 were diagnosed with a nonmalignant disease. We excluded 66 patients who did have a thoracotomy for the following reasons: exploratory thoracotomy

Comment

The results of this study challenge the current definition of an “incomplete resection,” which traditionally has included two pathologic findings, residual tumor at the resection margin or a positive highest mediastinal nodal station. Our clinicians considered a positive resection margin as an important risk factor for postoperative recurrence in NSCLC as reflected in its power in predicting ajuvant therapy. The finding that positive highest nodal station sampled at thoracotomy was not a

Acknowledgements

Doctors Guyatt and Cook are Career Scientists of the Ontario Ministry of Health. This study was supported by the Ontario Ministry of Health. Doctor Walter holds a National Health Scientist award from Health Canada.

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1

The members of the Canadian Lung Oncology Group are listed in Appendix A.

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