title: Characteristics of tumor extension requiring bronchoplasty and pneumonectomy in patients with lung cancer and positive bronchoscopic findings.
abstract: OBJECTIVE
  The characteristics of tumor extension determine whether pneumonectomy or lobectomy with bronchoplasty should be performed for central lung cancer. We investigated how the characteristics of tumor extension determined the operative methods and the surgical outcomes.
  
  
  METHODS
  We conducted a retrospective chart review of 151 patients with positive bronchoscopic findings who underwent lung cancer operations between January 1995 and March 2002. Twenty-five patients underwent pneumonectomy, 88 underwent lobectomy/segmentectomy (Lob/Seg), and 38 underwent Lob/Seg with bronchoplasty.
  
  
  RESULTS
  Pathologic staging was higher in the pneumonectomy group than in the Lob/Seg groups, with or without bronchoplasty (P = 0.002). Interlobar extension and hilar lymph node involvement were more frequent, and mucosal invasion was less frequent, in the pneumonectomy group than in the Lob/Seg with bronchoplasty group. The frequencies of all specific pulmonary complications and 30-day mortality were similar among the three groups. The 5-year overall survival rates were 23.7%, 51.5%, and 72.8% for the pneumonectomy, Lob/Seg, and Lob/Seg with bronchoplasty groups, respectively (P = 0.0004). There was a significant difference in survival between patients with mucosal and those with submucosal types of lung cancer (P = 0.0114).
  
  
  CONCLUSIONS
  Lob/Seg with bronchoplasty was feasible without a higher risk of operative complications or poorer long-term survival. The nature of tumor extension was important in the selection of operative methods and in predicting survival.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sekine
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Masako
authors.initials: M
authors.lastname: Chiyo
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.forename: Akira
authors.initials: A
authors.lastname: Iyoda
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Shibuya
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Iizasa
authors.forename: Takehiko
authors.initials: T
authors.lastname: Fujisawa
mesh_terms: D000368:Aged; D001980:Bronchi / Q000601:surgery*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate