Original article: general thoracic
The natural history of recurrence after bronchoplastic procedures for non-small cell lung cancer

https://doi.org/10.1016/S0003-4975(03)00337-0Get rights and content

Abstract

Background

The natural course of recurrence after bronchoplastic procedures for non-small cell lung cancer (NSCLC) has not been described.

Methods

Sex, age, tnm-stage, histology, neoadjuvant chemotherapy, disease-free interval (months), exact localisation of tumour recurrence, time between first and second recurrence (months), survival after first and second recurrence (months), causes of death were retrospectively recorded in 83 patients operated between December 1993 and July 2001.

Results

One patient was lost to follow-up, five resections were nonradical. Survivors’ follow-up lasted 5 to 100.7 months (mean 43.3). Fourteen patients (14.4%) died tumor free. Eleven (13.2%) distant recurrences were diagnosed 1 to 42 months (mean 10.6) postoperatively, eight (9.6%) died 0 to 17 months (mean 7.55) after diagnosis. Nine local recurrences (10.8%)–5 unifocal, 4 multifocal–occurred 2 to 35 months (mean 17.3) postoperatively, eight died 0 to 8 months (mean 2.13) after diagnosis. Nine mixed recurrences (10.8%)–1 synchronous, 8 metachronous–were found (14.8%) 2 to 21 months postoperatively (mean 8.3). All died 4 to 41 months (mean 17.83) after diagnosis. Fourteen mediastinal lymph node recurrences occurred, ten as a primary recurrence and four as secondary. Lymph nodes were involved in all multifocal recurrences. Intrabronchial recurrence was observed in five patients and was always a result of progressive regional lymph node recurrence.

Conclusions

The pattern and natural history of recurrence cannot be sufficiently explained by stage and surgical radicality and suggest different genetic characteristics of the primary tumor. In case of reoperation due to intrabronchial recurrence adjuvant mediastinal irradiation should be considered.

Section snippets

Patients and methods

Between December 1993 and July 2001 109 bronchoplastic procedures were performed in our department. Histiocytoma, adenoidcystic carcinoma, neuroendocrine carcinoma grade I and III, and metastasis of extrathoracic origin were excluded from analysis.

Postoperative routine follow-up consisted of a bronchoscopy, chest roentgenography, chest computed tomography (CT) every 6 months during the first 2 postoperative years and annual restagings from the third to the fifth postoperative year. Radiologic

Results

Eighty-three patients were included in the study. Only 1 patient was lost to follow-up. There were 66 men (79.5%) and 17 women (20.5%) aged between 26 and 76 years old (mean 58.4 years old, median 61 years old, SD 10.67). Five patients received neoadjuvant chemotherapy.

Comment

The question of postoperative tumour recurrence not only depends on local surgical radicality (which of course remains the primary goal of resection). E.g. the detection of malignant cells in preoperative pleural lavage negatively influences long term survival and underlines the problem of clinical and histological understaging [7]. The negative prognostic influence of Dehydrol-dehydrogenase present in tumour tissue points at the influence of molecular mechanisms which are not evaluated in

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