Surgical therapeutic strategy for non-small cell lung cancer with (N2) mediastinal lymph node metastasis / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the surgical therapeutic strategy for non-small cell lung cancer (NSCLC) with (N2) mediastinal lymph node metastasis.</p><p><b>METHODS</b>The clinical data of 325 patients with N2 NSCLC treated surgically between 1961 and 1995 were analysed.</p><p><b>RESULTS</b>The over-all 5-year survival rate was 19.6%. Survival was higher in patients with radical resection than with palliative resection, with squamous-cell carcinoma than with adenocarcinoma, with sleeve lobectomy and pneumonectomy than with regular lobectomy, with 1 to 3 mediastinal metastatic lymph nodes than those over 4, and with adjuvant therapy (chiefly postoperative radiotherapy) than without. All these differences were statistically significant (P < 0.05). There was no 5-year survivor in patients with T3 or T4 tumor, nor in those with distant metastasis.</p><p><b>CONCLUSION</b>It is suggested that surgery is the best choice for N2 NSCLC patients with T1 or T2 tumor, with non-adenocarcinoma, and with metastatic mediastinal lymph nodes less than 4 in number. Surgery is probably not a good choice in those with T3 tumor varieties. At operation, radical resection of the tumor and systematic removal of all hilar and mediastinal lymph nodes are essential for disease staging and survival improvement. Adjuvant therapy may improve long-term survival and is especially indicated in patients with residual tumor and/or metastatic mediastinal lymph nodes over 3 in number.</p>

Comparison of clinical and surgico-pathological TNM stage of 2007 lung cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>An accurate clinical TNM staging of lung cancer is essential for the precise determination of the extent of the disease in order that an optimal therapeutic strategy can be planned. This is especially true in patients with marginally resectable tumors. Clinical over-staging of the disease may deny a patient the benefit of surgery, whereas under-staging may oblige a patient to accept a fruitless or even harmful surgery. We aimed to analyze preoperative clinical (c-TNM) and postoperative surgico-pathologic staging (p-TNM) of lung cancer patients in order to evaluate the accuracy of our clinical staging and its implications on the surgical strategy for lung cancer.</p><p><b>METHODS</b>We did a retrospective comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer surgically treated from January 1999 to May 2003. Preoperative evaluation and c-TNM staging of all patients were based on physical examination, laboratory studies, routine chest X-ray and CT scan of the chest and upper abdomen. Other examinations included sputum cytology, bronchoscopy, abdominal ultrasonography, bone scintiscan, brain CT/MRI, and mediastinoscopy whenever indicated.</p><p><b>RESULTS</b>In the present study the comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer revealed an overall concurrence rate of only 39.0%. In the entire series the extent of disease was clinically underestimated in 45.2% and overestimated in 15.8% of the patients. Among all c-TNM stages the c-IA/B stage of 1105 patients gave the highest rate (55.2%) of underestimating the extent of disease. Clinical staging of T subsets was relatively easy with an overall accuracy rate of 72.9%, while that of N subsets was relatively more difficult with an overall accuracy rate of 53.5%. Analysis also showed that c-IV stage may not be an absolute contraindication to surgery, because in half of the patients, c-M1 turned out to be p-M0, providing the possibility of resectional surgery depending on the status of T and N.</p><p><b>CONCLUSION</b>For reasons to be further determined, the present preoperative clinical TNM staging of lung cancer remains a crude evaluation. Further efforts to improve its accuracy are needed.</p>

Clinical analysis of surgical treatment of primary tracheal tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical experiences in treating primary tracheal tumors by surgery.</p><p><b>METHODS</b>The clinical data concerning 70 surgically treated patients between 1968 and 2001 were retrospectively analyzed.</p><p><b>RESULTS</b>There were 39 sleeve tracheal resections, 13 carinal resections, 10 lateral tracheal wall resections, 5 local enucleations, and 1 pneumonectomy. The tumors in 2 patients were unresectable. The morbidity rate was 31% (22/70) and operative 30-day mortality for resection with primary reconstruction was 8% (4/52). The tumors were benign in 14 and malignant in 56 cases. The most common malignant tumors were adenoidcystic carcinoma (45%) and squamous cell carcinoma (23%). The cases of benign tracheal tumors were followed up for an average of 5.7 years. After resection for malignant tumors, the overall 5- and 10-year survival rates were 64% (21/33) and 54% (14/26), respectively.</p><p><b>CONCLUSIONS</b>Surgical resection is the most effective treatment of tracheal tumors. Tracheal resection and reconstruction is the treatment of choice for primary tracheal tumors. Benign tumors should be resected conservatively with preservation of tracheal parenchyma. The reduction of operative complications are key points of good surgical results.</p>