Although it is well-known that excessive surgical stress augments the growth of residual cancer and metastasis, whether surgical stress is increased according to the degree of surgical manipulation and can consequently lead to the enhancement of cancer metastasis has not been examined in lung cancer. The aim of this study was to examine whether lung manipulation has an effect on the survival of patients undergoing resection for non-small cell lung cancer (NSCLC).
Data was collected prospectively on 164 patients undergoing open lung resection and mediastinal nodal dissection by a single surgeon in a thoracic unit between 2001 and 2003 for Stage 1-IIIA NSCLC. Pre-, intra-, and postoperative variables were collected from medical records and survival data obtained from follow-up files and personal confirmation. The patients were sub-divided into two groups; G1 - frozen section + lung resection (n=69) and G2 - lung resection only (n=95).
Both groups were equally matched for sex and age. FEV1 of patients in G1 was 2.43 + 0.86L vs 1.97 + 0.69L in G2 (p=0.07). 23 patients had pre-operative chemotherapy and 3 patients had chemo-radiotherapy in G2. There was no significant difference in the pathological staging of patients in either groups (Stage I-43% vs 46%; Stage II - 38% vs 32%; Stage IIIA - 18% vs 23%). Observed 3-year stage specific survival was not significantly different between the two groups (Stage I-73% vs 70%; Stage II - 57% vs 54%; Stage IIIA - 16% vs 17%; p=0.4).
Lung manipulation to obtain histological confirmation prior to resection appears not to have a definite deleterious effect on medium term survival in patients with surgically resected NSCLC.
This study may have far reaching implications for patients undergoing VATS lobectomies.
S. Ghosh, None.