EFFECTS OF RESECTION METHOD EFFECTS OF RESECTION METHOD

TO SURVIVAL IN N1 NON-SMALL TO SURVIVAL IN N1 NON-SMALL

CELL LUNG CANCERCELL LUNG CANCER

• Yedikule Chest Disease and Thoracic

Surgery Education and Research Hospital

• OBJECTİVEOBJECTİVE

• To determine the efficacy of resection method to

survival in N1 non-small cell lung cancer with

lymph metastasis

• A retrospective study between January 1998-

December 2006

• 195 patient with N1 lymph node involvement

• Patients with T4 tumor and T3 superior sulcus tumor

were kept out of this study

• Patients underwent incomplete surgery, patients

with synchronous primary focus in lung and patients

underwent complementary pneumonectomy were

also kept out of this study

• 162 patients with T1,T2 and T3 tumor underwent

complete surgical resection were examined

retrospectively

• Average patient age -> 56.9 (39-78)

• 156 male (%96.3), 6 female (%3.7)

• Mediastinoscopy -> performed to 151 (%93.2)

patients

Resection Type

Lobectomy 56 (% 34.6)

Sleeve Lobectomy 21 (% 12.9)

Bilobectomy 14 (% 8.6)

Pneumonectomy 71 (%43.9)

Other procedures (Chest wall resection, diaphragm resection )

19 (%11.7)

Resection type performed

Pneumonectomy Causes (n=71)

Pneumonectomy CausePneumonectomy Cause

Interlober fissure invasion 46 (%64.8)

Invasion to central structures* 21 (%29.6)

Fixed interlober N1 4 (%5.6)

*Lesions which do not permit vascular and bronchial

reconstruction

Distribution of operative mortality

Mortality rate according to resection type

Lobectomy 5 (%6.6)

Pneumonectomy 4 (%5.5)

Bilobectomy 1 (%7.7)

Mortality rate in N1 group

Interlober N1 (11#) 5 (%9.3)

İntrapulmoner N1 (12,13,14 #) 5 (%5.4)

Hiler N1 (10#) 0

Distribution according to stage in 162 patient

T115 (%9.3)

T2 78 (%48.1)

T3 69 (%42.6)

Distribution according to N1

Hiler N1 (10#) 15 (%9.3)

İnterlober N1 (11#) 54 (%33.3)

İntrapulmoner N1 (12,13,14 l.n) 93 (%57.4)

• All cases were consulted in terms of oncologic

therapy.

• All patients examined at 6 months intervals for

relapses, local relapses, synchronous primary

tumor or metastasis.

• 3 patient postoperatively exited follow-up.

• Average follow-up period 29.3±21.4 (3 -106

month) month

• The beginning of survival time was accepted as

operation time, and the interval was calculated

according to death time or last follow-up time.

Statistics

• For average and frequency comparisons chi-square test, Fisher’s exact test and one-way ANOVA test were performed.

• For prognostic factors (cell type, T condition, tumor dimension, resection type) survival analysis were performed.

• Survivals were calculated according to “Kaplan-Meier” survival analysis (operation day counted as zeroth day)

• Effect of every variable to survival were examined with “log-rank” test. Values ≤ 0.05 were found as statistically significant.

Effects of other factors in N1 subgroups

Age p=0.92

Gender p=0.61

Histologic type p=0.54

Tumor dimension p=0.96

Resection Type p=0.54

Extended resection applicationExtended resection application p=0.02p=0.02

Beyond age 60Beyond age 60 p=0.02p=0.02

Resection type rate in Interlober Resection type rate in Interlober N1 (11N1 (11#) patientpatient

Lobectomy 13 (%24.1)

Bilobectomy 7 (%13.0)

Pneumonectomy 34 (%63.0)

Bilobectomy and/or pneumonectomy resection

types were found statistically significant (p<0.001)

Patients with Interlober N1

(11#)• T state (p=0.32), histologic type (p=0.81), tumor

dimension (p=0.77) were not found significant

• Patients underwent lobectomy %65.2

• Patients underwent bilobectomy and

pneumonectomy ,the survival rate was %49.8,but

was not stasistically significant (p=0.71)

Our clinic approach in patients with interlober N1 (11#)

• Right upper lobe tumors mobile 11s----------RUL

• Right upper lobe tumors fixed 11 s----------Sleeve RUL

• Right upper lobe tumors mobile/fixed 11 i---

Pneumonectomy

• Right lower lobe tumors mobile/fixed 11 i---RLBL

• Right lower lobe mobile/fixed 11 s---Pneumonectomy

• Left tumors fixed interlober N1-----Pnneumonectomy

• Left tumors mobile interlober N1-----Lobectomy

• Survival analysis in N1 patients show no

signifigance in histologic type subgroups

(p=0.49).

5 years survival period in all N1 patient

• Lobectomy --------------------------------%47.7

• Sleeve lobectomy------------------------%47.6

• Bilobectomy and -------------------------%57.5

• Pneumonectomy--------------------------%56.3

Statistically no difference between surgical types

(0.76)

Result Result

• There were no relations between resection type

and survival rate in completely resected N1

patients.

• This study showed that N1-I patients did not have

survival advantage with pneumonectomy, but

pneumonectomy endications were changable.

• Broadly discussed studies may only show that

resection type must change or not due to N1.