title: Is the initial feasibility of lobectomy for stage I non-small cell lung cancer in severe heterogeneous emphysema justified by long-term survival?
abstract: BACKGROUND
  The feasibility of anatomical lobectomy in patients with bronchial carcinoma in an area of severe heterogeneous emphysema whose respiratory reserve is outside operability guidelines has previously been confirmed. A review was undertaken to determine whether this approach is justified by long-term survival.
  
  
  METHODS
  A single surgeon's 8 year experience of 118 consecutive patients (74 men) of median age 70 years (range 45-84) who underwent upper lobectomy for pathological stage I non-small cell lung cancer (NSCLC) was reviewed. The preoperative characteristics, perioperative course and survival of the 27 cases with severe heterogeneous emphysema of apical distribution and a predicted postoperative forced expiratory volume in 1 s (ppoFEV(1)) of <40% (lobarLVRS group) were compared with the remaining 91 cases with a ppoFEV(1) of >40% (control group).
  
  
  RESULTS
  Postoperative mortality was 1 of 27 in the lobarLVRS group and 2 of 91 in the control group (p = NS). Five-year survival in the lobarLVRS group was 35% compared with 65% in the control group without concomitant severe emphysema (p = 0.001), although rates of tumour recurrence were similar.
  
  
  CONCLUSIONS
  Long-term survival after lobarLVRS for stage I lung cancer is limited by physiological rather than oncological factors. However, outcomes are still better than those reported for any other modality of treatment in this group of high-risk patients. This finding justifies the decision to offer lobectomy in these selected cases.
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Martin-Ucar
authors.forename: Khaleel R
authors.initials: KR
authors.lastname: Fareed
authors.forename: Apostolos
authors.initials: A
authors.lastname: Nakas
authors.forename: Paul
authors.initials: P
authors.lastname: Vaughan
authors.forename: John G
authors.initials: JG
authors.lastname: Edwards
authors.forename: David A
authors.initials: DA
authors.lastname: Waller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D016019:Survival Analysis