Minimal Resection for Bronchogenic ...

Minimal Resection for Bronchogenic Carcinoma

Pneumonectomy and lobectomy are the standard processs performed for treatment of resectable bronchogenic carcinoma. However, about patients with resectable tumors are not candidates for these proceedings and minimal resection, ie, wedge resection or segmentectomy, has been used as an effective treatment alternative. [1-9]

We reviewed our experience with wedge resection and segmentectomy for resectable bronchogenic carcinoma across the last ten years. The reasons for minimal resection were determined. The survival and return rates in this population were determined and compared to that being reported by means of other authors for patients undergoing similar resections, as well as for patients undergoing pneumonectomy and lobectomy. Thirty day operative mortality, detail of operating time, and fulness of postoperative hospital stay was determined for patients undergoing minimal resection and compared to those undergoing lobectomy and pneumonectomy.

MATERIALS AND METHODS

The records of all patients in whom bronchogenic carcinoma was diagnosed from Jan 1 1977 to Feb 28 1987 were obtained from the Tumor Registries at The Biloxi Veterans Administration Medical Center and Keesler Medical Center Those who underwent wedge resection or segmentectomy for resectable bronchogenic carcinoma were reviewed, and the records of all patients who underwent lobectomy or pneumonectomy for stage I (T1N0 or T2N0) disease were reviewed. fresh follow-up was obtained on all living patients.

Preoperative evaluation included history and physical exam, chest x-ray film, laboratory analysis, pulmonary function experiments lung perfusion scan, and bronchoscopy Other studies, ie, tomograms, computerized axial tomography of the chest and abdomen, and bone scan were obtained as indicated. Surgical techniques included the use of a double lumen endotrachael tube, pulmonary artery catheters and arterial catheters, use of stapling devices for wedge resection, routine nodal sampling, and epidural catheter placement.

All patients were evaluated for at least common year after resection. Raditon therapy was enlist in one's serviceed only for proven recurrent disease.

RESULTS

A total of 1741 patients were diagnosed as having bronchogenic carcinoma from Jan 1 1977 to Feb 28 1987 at The Biloxi Veterans Administration Medical Center (n = 547) and Keesler Medical Center (n = 1194) a certain quantity of 317 consecutive patients underwent potentially curative resection with pneumonectomy (n = 93) lobectomy (n = 209) wedge resection (n = 14) and segmentectomy (n = 1)

All patients who underwent minimal resection were stage I (TIN0 or T2N0) and all patients had peripheral lesions that were amenable to wedge resection.

The in the greatest degree common reason for minimal resection was impaired pulmonary function. We generally defined this as a predicted [FEVsub1] of 800 ml after resection. However, each case is individualized with multiple factors considered, ie, arterial life-current gas analysis and exercise tolerance. Misdiagnosis at the time of surgery occurr three times in our series, one time with a suspected benign lesion that prov to be malignant (bronchalveolar carcinoma), and twice with a presum metastatic lesion that prov to be bronchogenic carcinoma (well differentiated adenocarcinoma, bronchalveolar carcinoma).

In three patients, wedge resection was done because of previous contralateral lung resections, and in pair patients, wedge resection was accomplished because of synchronous bronchogenic carcinomas in different lobes (Table 1)

Survival was calculated from date of resection until death or until the extremity of the study period. Median longitudinal dimensions of follow-up for patients remaining alive and disease at liberty was 41 months. There were 11 patients eligible for studious mood for three-year survival, and the disease emancipated was 41 months. There were 11 patients eligible for contemplation for three-year survival, and the disease-free and overall survival was 82 percent There were six patients eligible for studious mood for five-year survival, and the disease-free and overall survival was 67 percent and 83 percent The five-year actuarial survival was 77 percent (Fig. 1)

Five patients discloseed recurrence, with one of these patients alive at seven years since resection. solitary one patient developed a local recurrence; the others expanded recurrence manifested as distant metastasis. All patients who died had resort at the time of death. The longest survivor is seven years with no evidence of disease.

Our operative mortality in this consecutive series of patients who underwent wedge resection was naught percent. The median amplification of surgery for minimal resection was 90 minutes as compared to 215 minutes for lobectomy and 240 minutes for pneumonectomy, which was statistically significant (Mann-Whitney exhibition p=0.0001 for lobectomy and p=00001 for pneumonectomy, Table 2) the median long duration of postoperative hospital stay after minimal resection was nine days, compared to 14 days after lobectomy and 12 days after pneumonectomy. steady though less for minimal resection, this was not statistically significant (Mann-Whitney touchstone p=0.22 for lobectomy and p=087 for pneumonectomy, Table 3)