EFFECTS OF RESECTION METHOD TO SURVIVAL IN N1 NON-SMALL CELL LUNG CANCER

1. EFFECTS OF RESECTION METHOD TO SURVIVAL IN N1 NON-SMALL CELL LUNG CANCER • Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital

2. OBJECTİVE • To determine the efficacy of resection method to survival in N1 non-small cell lung cancer with lymph metastasis

3. A retrospective study between January 1998-December 2006 • 195 patient with N1 lymph node involvement • Patients with T4 tumor and T3 superior sulcus tumor were kept out of this study • Patients underwent incomplete surgery, patients with synchronous primary focus in lung and patients underwent complementary pneumonectomy were also kept out of this study

4. 162 patients with T1,T2 and T3 tumor underwent complete surgical resection were examined retrospectively • Average patient age -> 56.9 (39-78) • 156 male (%96.3), 6 female (%3.7) • Mediastinoscopy -> performed to 151 (%93.2) patients

5. Resection type performed

6. Pneumonectomy Causes (n=71) *Lesions which do not permit vascular and bronchial reconstruction

7. Distribution of operative mortality

9. All cases were consulted in terms of oncologic therapy. • All patients examined at 6 months intervals for relapses, local relapses, synchronous primary tumor or metastasis. • 3 patient postoperatively exited follow-up. • Average follow-up period 29.3±21.4 (3 -106 month) month • The beginning of survival time was accepted as operation time, and the interval was calculated according to death time or last follow-up time.

10. Statistics • For average and frequency comparisons chi-square test, Fisher’s exact test and one-way ANOVA test were performed. • For prognostic factors (cell type, T condition, tumor dimension, resection type) survival analysis were performed. • Survivals were calculated according to “Kaplan-Meier” survival analysis (operation day counted as zeroth day) • Effect of every variable to survival were examined with “log-rank” test. Values ≤ 0.05 were found as statistically significant.

12. Bilobectomy and/or pneumonectomy resection types were found statistically significant (p<0.001)

13. Patients with Interlober N1 (11#) • T state (p=0.32), histologic type (p=0.81), tumor dimension (p=0.77) were not found significant • Patients underwent lobectomy %65.2 • Patients underwent bilobectomy and pneumonectomy ,the survival rate was %49.8,but was not stasistically significant (p=0.71)

14. Our clinic approach in patients with interlober N1 (11#) • Right upper lobe tumors mobile 11s----------RUL • Right upper lobe tumors fixed 11 s----------Sleeve RUL • Right upper lobe tumorsmobile/fixed 11 i---Pneumonectomy • Right lower lobe tumors mobile/fixed 11 i---RLBL • Right lower lobe mobile/fixed 11 s---Pneumonectomy • Left tumors fixed interlober N1-----Pnneumonectomy • Left tumors mobile interlober N1-----Lobectomy

15. Survival analysis in N1 patients show no signifigance in histologic type subgroups (p=0.49).

16. 5 years survival period in all N1 patient • Lobectomy --------------------------------%47.7 • Sleeve lobectomy------------------------%47.6 • Bilobectomy and -------------------------%57.5 • Pneumonectomy--------------------------%56.3 • Statistically no difference between surgical types (0.76)

17. Result • There were no relations between resection type and survival rate in completely resected N1 patients. • This study showed that N1-I patients did not have survival advantage with pneumonectomy, but pneumonectomy endications were changable. • Broadly discussed studies may only show that resection type must change or not due to N1.