The impact of the type of resection on survival in patients with N1 non-small-cell lung cancers.

Objective: Complete resection is the therapy of choice in non-small-cell lung cancer (NSCLC). There is no agreement on the type of resection, especially when interlobar N1 disease is present. The present study explored the effect of the type of resection on survival in the presence of N1 disease.
Method: Medical records of 195 patients with NSCLC who underwent resection between 1998 and 2006 and whose histopathological examination showed N1 disease were reviewed retrospectively. This study included 162 patients with T status of T1, T2 or T3, who had complete resection (excluding superior sulcus tumours). The patients were divided into three groups, namely hilar N1 (n=15, 9.3%), interlobar N1 (N1-i) (n=54, 33.3%) and lobar N1 (n=93, 57.4%). Frequency comparisons were carried out by chi-square test. Survival rates were calculated by the Kaplan-Meier method and compared by log-rank test after patients who had operative mortality (n=10, 6.2%) were excluded.
Results: Seventy-seven patients (47.5%) had lobectomy, 14 (8.6%) had bilobectomy (BL) and 71 (43.8%) had pneumonectomy (PN). Twenty-one of these patients (13.0%) had sleeve lobectomy and 19 had (11.7%) additional interventions (such as resection of the diaphragm or thoracic wall). Among all N1 patients, 5-year survival rate was 56.9% in patients who had BL or PN and 46.8% in patients who had lobectomy, a difference not statistically significant (p=0.09). Similarly, there was no significant difference between patients who had sleeve resection and PN (p=0.58). The type of resection was not found related to survival in the presence of interlobar (p=0.75). Similarly, type of resection was not significantly associated with survival in patients with hilar N1 (p=0.86).
Conclusion: Those who had PN or BL had a higher survival rate, which was statistically insignificant. Further studies are required to determine whether or not the type of resection should be changed as a result of N1 only.
(Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)