Prognostic implications of a positive bronchial resection margin

Objective: This retrospective study evaluates probability of survival and m ode of recurrence in patients with a microscopically positive bronchial res ection margin following resection for primary bronchogenic carcinoma, as we ll as influence of radiotherapy on survival. Methods: From January 1986 to July 1997, 40 patients had a microscopically positive bronchial resection m argin following a macroscopically complete resection (17 lobectomies, three bilobectomies, four sleeve-lobectomies, and 16 pneumonectomies). Tissue di agnosis was squamous cell carcinoma in 32 patients, adenocarcinoma in four, adenosquamous carcinoma in two and neuroendocrine carcinoma in two. Lymph node status was N0 in 14 patients, N1 in 10, and N2 in 16. The bronchial ma rgin contained carcinoma in situ in 20 patients, invasive mucosal carcinoma in five, and peribronchial infiltration in 15. All patients except the thr ee most recent underwent adjuvant radiation therapy. Results: At the conclu sion of the study (January 31st, 1999), 30 patients had died: two with post -operative complications, 17 with progressive disease, ten without relation to cancer, and one under undefined circumstances. Six of 10 unrelated deat hs were interpreted as respiratory complications of radiotherapy. Recurrent disease appeared in 24 patients (60%). Nineteen had progression of initial disease (47.5%): metastatic spread in 12 (30%), isolated local recurrence in four (10%), and combined local recurrence and metastases in three (7.5%) . Five patients developed metachronous cancer, with bronchial location in f our (10%) and laryngeal in one (2.5%). 5-year survival (Kaplan-Meier) in 20 patients with carcinoma in situ was 38.7 +/- 13.7% (median 31 months), but rose to 55.0 +/- 16.6% when excluding seven deaths not related to cancer ( five of whom were secondary to radiotherapy) (chi(2) = 3.080; P = 0.0792). Survival in 13 patients classified NO was 51.3 +/- 16.3% (median 61 months) , and 71.1 +/- 18.0% following exclusion of unrelated deaths (chi(2) = 3.93 9; P = 0.0472). Adverse prognosis of peribronchial infiltration was correla ted to a positive N status (13 N2 and 2 N1), 5-year survival being 20.0 +/- 10.3% (median: 18 months). Conclusions: Prognosis of peribronchial infiltr ation is similar to N2 disease. In situ carcinoma does not influence surviv al per se. Local control of disease is probably in part due to radiotherapy . However, the high prevalence of unrelated late deaths suggests an adverse impact of radiotherapy on survival. (C) 2000 Elsevier Science B.V. All rig hts reserved.