TUMOR PRESENCE AT RESECTION BOUNDARIES AND LYMPH-NODE METASTASIS IN BRONCHIAL-CARCINOMA PATIENTS

A prospective study was performed analyzing the bronchial resection bo undaries of 120 patients operated on for lung carcinoma. The resection boundary, maximum tumor diameter, distance between tumor and resectio n boundary, and lymph-node stage were analyzed by serial sections of t he surgical specimens (lobes and lungs). The following results were ob tained: 20/120 cases (17 %) displayed microscopic tumor invasion of th e resection boundary (R1 status), most frequently adenocarcinoma (21 % ). The R1 status was closely associated with the distance between tumo r and resection boundary and postsurgical lymph-node stage (pN stage): all 8 tumors excised at distance 1 mm or less from the bronchial rese ction boundary revealed bronchial submucous tumor growth, whereas none of the tumors located more than 20 mm from the resection boundary was found to display tumor invasion of the bronchial boundary. Curative r esection was noted in all 40 tumors operated at pNO stage and in only 11 cases (69 %) of tumors with distant lymph-node metastases (pN3 stag e). No relationship between tumor infiltration of the resection bounda ry and type of resection was seen. The data indicate that a) intra-ope rative control of bronchial resection boundaries is necessary in all l ung-carcinoma patients with central tumor localization less than 20 mm from the proposed resection boundary; b) a ''safety distance'' betwee n resection boundary and tumor boundary is of specific importance in b ronchial carcinoma with lymph-node metastases.