Treatment and survival after lung resection for non-small cell lung cancerin patients with microscopic residual disease at the bronchial stump

Objective: The aim of this study is a retrospective evaluation of survival in patients who had undergone lung resection for non-small cell lung cancer and in whose microscopic residual disease at the bronchial resection margi n was found, according to the type of infiltration, histology, lymph node i nvolvement and postoperative treatment. Methods: A total of 1384 patients u nderwent lung resection for non-small cell lung cancer at the Thoracic Surg ery Unit of the University of Siena from 1983 through 1998. All patients un derwent complete mediastinal lymphadenectomy and this guaranteed an accurat e stadiation. Staging was done according to the TNM and UICC classification s. Residual microscopic disease at the bronchial resection margin was divid ed in mucosal microscopic residual disease and extramucosal microscopic res idual disease. Patients dying within 30 days from operation were excluded f rom survival analyses. Survival was analysed by the product limit method of Kaplan and Meier and curves were compared using the log-rank test. Results : Microscopic residual disease was found postoperatively at the bronchial m argin in 3.39% (47/1384) of all patients undergoing lung resection for non- small cell lung cancer. Thirty patients (2.16%) had extramucosal microscopi c residual disease and 17 (1.22%) had mucosal microscopic residual disease. Seventeen patients received adjuvant radiotherapy after operation, two pat ients underwent completion pneumonectomy; no chemotherapy was given. Median survival for the whole group was 22 months. The probability of survival wa s not significantly (P > 0.05) correlated with the type of infiltration, no r with lymph node disease, neither with histology, although patients with s quamous cell carcinoma had a median survival of 30 versus 12 months of pati ents with adenocarcinoma. The probability of survival could not be correlat ed with the administration of adjuvant radiotherapy. Conclusions: A frozen- section analysis of the bronchial resection margin and peribronchial tissue should be made in all patients with endobronchial tumour. We suggest that patients with microscopic residual tumour and stage I or II disease should undergo reoperation, if possible. In patients with documented N2 disease we don't recommend re-operation; extending the magnitude of the resection is unlikely to alter their outcome. Choice treatment for these patients is rad iotherapy. (C) 1999 Elsevier Science B.V. All rights reserved.