RISK ANALYSIS AND LONG-TERM SURVIVAL IN PATIENTS UNDERGOING EXTENDED RESECTION OF LOCALLY ADVANCED LUNG-CANCER

Although locally advanced lung cancer frequently necessitates extended resections to preserve a chance for cure, a higher morbidity is assoc iated with extended resections. It is not known whether the increased morbidity is of relevance for the long-term outcome. It also remains u nclear whether exclusion of certain patients according to their risk f actors can diminish mortality in these patients. This study therefore investigated whether certain risk factors predispose patients undergoi ng extended pulmonary resections to increased morbidity or mortality. It also assessed the long-term survival. The cases of 126 consecutive patients with locally advanced lung cancer (stage T3 or T4) were prosp ectively documented. Seventy-five percent of the patients required an extended resection and 25% a nonextended resection. Extended resection s were associated with a significantly increased overall morbidity (p < 0.002). However, mortality, severe complications, or multiple compli cations were not significantly increased after extended resections. No risk Factor predisposed to an increased mortality. Risk factors that were associated with particular postoperative complications were patho logic ergonometry (p < 0.002), a positive cardiac score (p < 0.003), c oronary artery disease (p = 0.021), and an increased pulmonary risk sc ore (p < 0.05). Overall 3-year survival was 31%. Patients undergoing e xtended resections for stage T3 or T4 tumors with no residual tumor (7 0% of the patients) showed a 3-year survival of 33%. We conclude that postoperative mortality cannot be reduced by excluding patients on the basis of particular risk factors from operations that require extende d resections. If a patient is considered to be eligible to undergo pul monary resection, he or she can be considered to be eligible to underg o extended pulmonary resection. Because prognosis is dismal in nonrese cted locally advanced lung cancer, we recommend an aggressive surgical approach.