Local control of disease and survival following bronchoplastic lobectomy for non-small cell lung cancer

Background: This study was designed to determine whether bronchoplastic res ection could be an alternative to pneumonectomy in patients with operable p rimary lung cancer. Methods: From 1980 to 1996, 63 patients (59 males and f our females; mean age 62 +/- 7 years) underwent a bronchoplastic lobectomy for non-small cell lung cancer, indicated because of a disabled respiratory function in 34 patients, and performed electively in 29 patients. There we re 38 right upper lobectomies, four bilobectomies, one middle lobectomy com bined with lower lobe apical segmentectomy, ten left upper and ten left low er lobectomies. The bronchoplasty was a full sleeve in 24 patients, and a b ronchial wedge resection in 39. Results: A single patient died post-operati vely (1.6%). Specific procedure-related complications are summarized as fol lows: six anastomotic complications managed conservatively (9.5%), 15 space problems (23.8%), nine sputum retentions (14.2%). Pathologic staging class ified 30 patients in stage I, 21 patients in stage II, and 12 in stage IIIA . Estimated 5-year survival was 69.7 +/- 9.8% in stage I, 37.1 +/- 12.1% in stage II, and 8.3 +/- 8.0% in stage IIIA. Fourteen patients (22.2%) develo ped locoregional recurrence. Three of them died with local recurrence alone , whereas 10 developed metastatic progression; a single patient is alive fo llowing completion pneumonectomy. According to stage, three recurrences occ urred in stage I (10%), six in stage IT (28%), and five in stage IIIA (38%) . Actuarial freedom from local recurrence was significantly higher after el ective procedures (P = 0.019); there was a trend towards improved outcome f ollowing right-sided procedures (P = 0.079) and following wedge bronchoplas ty (P = 0.055). Five patients experienced a second primary cancer (7.9%), w hich was resected in four. Conclusion: Bronchoplastic resections achieve lo cal control and long-term survival comparable to standard resections in pat ients with stage I or II disease, and may be considered as a valuable alter native to pneumonectomy. (C) 1999 Elsevier Science B.V. All rights reserved .