The impact of residual tumor morphology on prognosis, recurrence, and fistula formation after lung cancer resection.
BACKGROUND
The prognosis and proper management of patients with microscopic residual tumor at the bronchial resection margins (bronchial R1) remain unclear.


METHODS
We performed a retrospective analysis of 74 patients who underwent pulmonary resection for lung cancer between 1976 and 2003 and had bronchial R1. The prognosis, pattern of the recurrence, and occurrence of the bronchopleural fistula (BPF) were analyzed according to the types of bronchial R1 morphology: direct extension (DIR, n = 11), peribronchial extension (PER, n = 54), and carcinoma in situ (CIS, n = 9).


RESULTS
Five-year survival rates of patients with DIR, PER, and CIS were 0, 10, and 63%, respectively. The patients with CIS showed significantly better prognosis than those with DIR and PER (p = 0.0006, p = 0.0009, respectively). No prognostic difference was observed between patients with DIR and PER (p = 0.1753). Recurrent disease developed in 43 patients (58%). Only one of nine patients with CIS (11%) had recurrence, whereas 6 of 11 patients with DIR (55%) and 36 of 54 patients with PER (67%) had disease relapse. The recurrence rate in the CIS group was significantly lower than those of the other two groups (CIS versus DIR, p = 0.036; CIS versus PER, p = 0.006, respectively). BPF formation was not detected in patients with CIS; however, BPF developed in 3 of 11 patients with DIR (27%) and 3 of 54 patients with PER (5.6%).


CONCLUSIONS
Residual tumor morphology influenced the prognosis of patients with postresection bronchial R1 disease.
Division of Thoracic Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Takeshi
T
Kawaguchi
Shun-ichi
S
Watanabe
Riken
R
Kawachi
Kenji
K
Suzuki
Hisao
H
Asamura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001983:Bronchial Fistula / Q000453:epidemiology / Q000209:etiology*; D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate