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Staging and resection of lung cancer with minimal invasion of the adjacent lobe

Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Department of Thoracic Surgery, Istanbul, Turkey

Received 1 June 2007; received in revised form 7 September 2007; accepted 10 September 2007.

^_* Corresponding author. Address: Yuzyil mah. Ksla Cad. Yesil zengibar sitesi, A-3 Blok, D-9 Bagcilar, Istanbul, Turkey. Tel.: +90 212 6641700; fax: +90 212 5472233. (Email: dradalet{at}hotmail.com).

Objective: Correct staging, optimal resection type, and prognosis for non-small cell lung cancer (NSCLC) with invasion of the adjacent lobe through the fissure have seldom been reported. Methods: We retrospectively evaluated 351 completely resected NSCLC patients between 1994 and 2004. Of these, 152 patients had T2 and 139 had T3 NSCLC confined in one lobe and 60 patients had T2 NSCLC that shows a limited growth through the interlobar fissure into the adjacent lobe (NSCLC-ALI). Types of resections performed in patients who have NSCLC-ALI were: pneumonectomy in 40, bilobectomy in 10, and lobectomy plus partial adjacent lobe resection (LPR) in 10. Survival rates of all patients were determined and factors affecting the survival were evaluated by univariate and multivariate analyses. A multivariate survival analysis of NSCLC-ALI patients including the resection type as a prognostic factor was also performed. Results: Survival of the patients with NSCLC-ALI was not statistically different from those with T3 disease (p = 0.67, log rank test) but was significantly poorer than remaining patients with simple T2 disease (p = 0.049, log-rank test). T status was found as a prognostic factor at multivariate analysis too (p = 0.037). The survival of patients who underwent pneumonectomy was significantly worse than the patient group who underwent bilobectomy or LPR (p = 0.04). There was no statistically significant difference between survival of the patients who underwent LPR and the patient group who underwent pneumonectomy or bilobectomy (p = 0.16). Hospital mortality was 6.6% (4/60) and they all underwent a pneumonectomy. During follow-up there was no local recurrence encountered in patients in LPR group. Conclusions: The prognosis of NSCLC with limited invasion of an adjacent lobe was found to be similar with that of T3 tumors. A resection type lesser than a pneumonectomy may be considered in these tumors.

Key Words: NSCLC • Adjacent lobe invasion • Staging • Resection