Journal List > J Lung Cancer > v.5(2) > 1050664

Park, Sa, Jeon, and Lee: The Patterns of Recurrence after Surgery for Non-small Cell Lung Cancer

Abstract

Purpose:

Recent progress in the surgical therapy for lung cancer is one of the best examples of the successful evolution of clinical medicine. We reviewed our experience to evaluate the surgical outcomes in patients with non-small cell lung cancer.

Materials and Methods:

We reviewed clinical records of 236 consecutive patients with proven primary non-small cell lung cancer who underwent complete removal of the primary tumor together with hilar and mediastinal lymph nodes from 1995 to 2005. The clinical characteristics, surgical methods, and recurrence patterns were analysed.

Results:

The patients of stage III and IV were 71 cases (35.9%) and 2 cases (1.0%) respectively, and neoadjuvant therapy was done in 62 patients. Lobectomy was the most common procedure (69.7%) performed and pneumonectomy was the least (5.6%). In 81 patients (40.9%) the recurrence was noted and the regional recurrence (27 cases, 13.6%) was less than systemic recurrence (54 cases, 27.3%). The main sites of regional recurrence were hilum (11 cases, 40.7%) and ipsilateral mediastinum (9 cases, 33.3%).

Conclusion:

These data indicated that our surgical methods were useful and effective, (J Lung Cancer 2006;5(2): 84-88)

REFERENCES

1.Ponn RB., LoCicero J 3rd., Daly BDT. Surgical treatment of non-small cell lung cancer. In:. Shields TW, LoCicero J, Ponn RB, Rusch VW, editors. editors.General Thoracic Surgery. 6th ed.Philadelphia; Lippincott Williams St Wilkins Co.;2005. p. 1548–1587.
2.Izbicki JR., Knoefel WT., Passlick B, et al. Risk analysis and long term survival in patients undergoing extended resection of locally advanced lung cancer. J Thorac Cardiovasc Surg. 1995. 110:386–395.
3.Dartevelle PG. Extended operation for the treatment of lung cancer. Ann Thorac Surg. 1997. 63:12–19.
4.Hata E., Miyamoto H., Tanaka M., Sakao Y., Harada R. Superradical operation for lung cancer: bilateral mediastinal dissection (BMD) with or without cervical dissection (CD). Lung Cancer. 1994. ll(Suppl 2):41–42.
5.Keller SM., Adak S., Wagner H., Johnson DH., Eastern Cooperative Oncology Group. Mediastinal lymph node dissection improves survival in patients with stages II and Ilia non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg. 2000. 70:358–365.
6.Cahan WG., Radical lobectomy. J Thorac Cardiovasc Surg. 1960. 39:555–572.
7.Naruke T: Suemasu K: Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg. 1978. 76:832–839.
8.Riquet M., Hidden G: Debesse B. Direct lymphatic drainage of lung segment to the mediastinal nodes. J Thorac Cardiovasc Surg. 1989. 97:623–632.
9.Hata E: Miyamoto H., Hayakawa K., Hayashida R. Rationale for extended lymphadenectomy for lung cancer. Theoretical Surg. 1990. 5:19–25.
10.Tsuchiya R., Asamura H: Kondo H, et al. Extended resection of the left atrium, great vessels, or both for lung cancer. Ann Thorac Surg. 1994. 57:960–965.
crossref
11.Yokoi K., Matsuguma H., Anraku M. Extrapleural pneumonectomy for lung cancer with carcinomatous pleuritis. J Thorac Cardiovasc Surg. 2002. 123:184–185.
crossref
12.Albain KS., Ruscfi VW. Crowly 丄), et ah Concurrent cisplatin/Etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small cell cancer: mature results of Southwest Oncology Group phase II study 88-05. J Clin Oncol. 1995. 13:1880–1892.
13.Thomas M., Rube C., Semik M, et al. Impact of preoperative bimodality induction including twice daily radiation on tumor regression and survival in stage III non-small cell lung cancer. J Clin Oncol. 1999. 17:1185–1193.
14.Grunenwald DH., Le Chevalier T., Arriagada R. et al. Results of surgical resection in stage IIIB non-small cell lung cancer (NSCLC) after concomittent induction chemo-radiotherapy 『Abstract]‘Lung Cancer. 1997. 18(Suppl):73. A280.
15.Grunenwald DH. Surgery for advanced stage lung cancer. Semin Surg Oncol. 2000. 18:137–142.
crossref
16.Paulson DL., Urschel Jr HC., McNamara JJ., Shaw RR. Bron-choplastic procedure for bronchogenic carcinoma. J Thorac Cardiovasc Surg. 1970. 59:38–48.
17.Roviaro GC., Varoli F., Rebuffat C, et al. Videothoracoscopic staging and treatment of lung cancer. Ann Thorac Surg. 1995. 59:971–974.
crossref
18.Walsh GL: O'Connor M: Willis KM, et al. Is follow-up of lung cancer patients after resection medically indicated and cost-effective? Ann Thorac Surg. 1995. 60:1563–1572.
19.Ichinose Y: Yano T., Yokotama H, et al. Postrecurrent survival of patients with non-small cell lung cancer undergoing a complete resection. J Thorac Cardiovasc Surg. 1994. 108:158–161.
20.Mitsudomi T., Nishioka K., Maruyama R, et al. Kinetic analysis of recurrence and survival after potentially curative resection of nonsmall cell lung cancer. J Surg Oncol. 1996. 63:159–165.
crossref
21.Williams BA: Sugimura H., Endo C, et al. Predicting poslrecurrence survival among completely resected nonsmall-cell lung cancer patients. Ann Thorac Surg. 2006. 81:1021–1027.

Table 1.
Extent of Resection
Resection   Number (%)
Lurig
  Lobectomy   138 (69.7)
  Lobectomy+   21 (10.6)
   Partial resection of luna   12
   Partial resection of chest wall   9
  Sleeve lobectomy   14 (7.1)
  Bi-lobectomy   14 (7.1)
  Pneumonectomv   10 (5.1)
  Pleuro-pneumonectomy   1 (0.5)
Lymph node
Ipsila.∗ mediastinal   182 (91.9)
  Ipsila.+contrala, mediastinal   16 (8.1)
   Contrala. No. 10 14
   Contrala. No. 4 2
Total   198 (100)

Ipsila.: ipsilateral, contrala.: contralateral

Table 2.
Primary Sites of Regional Recurrence
Sites Number (%)
Hilum 11 (40.7)
Ipsila.∗ mediastinum 9 (33.3)
Bronchial stump 3 (11.1)
Contrala. mediastinum 2 (7.4)
Lurig margin 1 (3.7)
Chest wall 1 (3.7)
Total 27 (100)

Ipsila.: ipsilateral, Contrala.: contralateral

Table 3.
Recurrence and Cancer Cell Type
Cell type (No) No. of recur (%) Total (%)
Regional recur Systemic recur
Adenocarcinoma (109) 16 (14.7) 35 (32.1) 51 (46,8)
SCO (62) 8 (12.9) 12 (19.4) 20 (32.3)
Large cell ca. (11) 1 (9.1) 4 (36.4) 5 (45.5)
Others (16) 2 (12.5) 3 (18.8) 5 (31.3)
Total (198) 27 (13.6) 54 (27.3) 81 (40.9)

SCC: squamous cell carcinoma

Table 4.
Primary Sites of Regional Recurrence according to Cancer Cell
Sites Number (%)
ADC SCC§ LCC Others
Hilum     8 3
Ipsila.∗ mediastinum 6 2   1
Bronchial stump 0 2   1
Contrala. 1 1    
  mediastinum
Lung margin 1      
Chest wall     1  
Total 16 (59.3) 8 (29.6) 1 (3.7) 2 (7.4)

Ipsila.: ipsilateral, Contrala.: contralateral, ADC: adenocarcinoma, §SCC: squamous cell carcinoma, LCC: large cell carcinoma

Table 5.
Cancer Stage and Recurrence Rates
Stage (No) Reaional recur Systemic recur Total
IA (37) 1 (2.7%) 8 (21.6%) 9 (24.3%)
IB (46) 2 (4.3%) 16 (34.8%) 18 (39.1%)
IIA (13) 2 (15.4% 3 (23.1%) 5 (38.5%)
IIB (29) 5 (17.2%) 8 (27.6%) 13 (44.8%)
IIIA (57) 14 (24.6%) 12 (21.1%) 26 (45.6%)
IIIB (13) 3 (23.1%) 4 (30.8%) 7 (53.8%)
IV (3) 0 3 (100%) 3 (100%)
Total (198) 27 (13.6%) 54 (27.3%) 81 (40,9%)
Table 6.
Surgical Application for Stage IIIB and IV
  Stage Procedure No
IIIB
  T4     7
  SVC∗ invasion Partial resection of SVC 2
  Satellite lesion at same lobe Lobectomy 2
  Carinal involvement Carinal reconstruction 1
  LA involvement Partial resection of LA 1
  Pleural seeding Pleuro-pneumonectomy 1
N3     6
  Contra-lateral No. 10 Resection 4
  Contra-lateral No. 4 Resection 2
IV (single organ metastasis)   3
  Rib (ipsilateral side) Partial resection of rib 1
  Lung (ipsilateral side) Partial resection of lung 1
  Kidney Nephrectomy 1

SVC: superior vena cava, LA: left atrium

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