Robert J. Ginsberg

Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer

BACKGROUND It has been reported that limited resection (segment or wedge) is equivalent to lobectomy in the management of early stage (T1-2 N0) non-small cell lung cancer. METHODS A prospective, multiinstitutional randomized trial was instituted comparing limited resection with lobectomy for patients with peripheral T1 N0 non-small cell lung cancer documented at operation. Analysis included locoregional and distant recurrence rates, 5-year survival rates, perioperative morbidity and mortality, and late pulmonary function assessment. RESULTS There were 276 patients randomized, with 247 patients eligible for analysis. There were no significant differences for all stratification variables, selected prognostic factors, perioperative morbidity, mortality, or late pulmonary function. In patients undergoing limited resection, there was an observed 75% increase in recurrence rates (p = 0.02, one-sided) attributable to an observed tripling of the local recurrence rate (p = 0.008 two-sided), an observed 30% increase in overall death rate (p = 0.08, one-sided), and an observed 50% increase in death with cancer rate (p = 0.09, one-sided) compared to patients undergoing lobectomy (p = 0.10, one-sided was the predefined threshold for statistical significance for this equivalency study). CONCLUSIONS Compared with lobectomy, limited pulmonary resection does not confer improved perioperative morbidity, mortality, or late postoperative pulmonary function. Because of the higher death rate and locoregional recurrence rate associated with limited resection, lobectomy still must be considered the surgical procedure of choice for patients with peripheral T1 N0 non-small cell lung cancer.

Staging and prognostic factors in small cell lung cancer: a consensus report

‘Division of Oncology, Department of Medicine, University Hospital, Zitrich (Switzerland); 2Department of Surgery, Mt. Sinai Hospital, Toronto (Canada); 3Divi 4Department of Internal Medicine, Birpebjerg Hospital, Copenhagen (Denmark); ‘NCI-Navy Medical Oncology Branch, Bethesda, MD (U.S.A.); 6Department OfRadiothcrapy, Medical Academy, Gdansk (Poland); ‘lnstiiut for Cancer Research, Vienna (A@&); ‘Section ofHematologylOncology, Department of Medicine, Dartmouth-HitchcockMedical Center, Hanover.NH (U.S.A.); ‘Department OfMedicine, Central Sygehusel. Hillerod {Denrrmk); and ‘ODepartment of Radiotherapy, Inrtitut Jules Bordet. Brwsels (Belgium)

Evaluation of the mediastinum by invasive techniques.

The value of invasive staging of the mediastinum is its greater accuracy in assessing the operability of lung cancer compared to noninvasive techniques. In expert hands, invasive mediastinal exploration results in little morbidity or mortality. For these reasons, we continue to use mediastinoscopy routinely in evaluating the mediastinum prior to advising thoracotomy for resection in the management of lung cancer.