Background: Possibility of curative resection by lobectomy for non-small cell lung cancer is often denied patients with compromised pulmonary reserve. Analysis of survival of such patients treated by wedge resection was compared with that of patients treated by standard resection, with both groups followed for 10 years.
Design: A prospective 5-year cohort study.
Methods: From 1988 to 1992, an observational cohort of 127 consecutive resected patients at Memphis VA Medical Center was divided into those receiving lobectomy in 81 cases and pneumonectomy in 15 cases (group I) versus 31 patients with compromised pulmonary reserve (group II), who had complete tumor excision by wedge resection. Preoperative clinical staging was corrected to surgical-pathological staging after demonstration of its superiority. Survival estimates were obtained by Kaplan-Meier method with curves compared by log rank tests, with all-cause mortality calculated from date of surgery.
Results: Extent of disease in group I was 58% stage I, 19% stage II, and 23% stage III. In group II, extent of disease was 84% stage I, 3% stage II, and 14% stage III. Group I median survival was 26 months with 30% 5-year survival; for group II, median survival was 30 months and 32%. Kaplan-Meier survival plots showed similar curves in groups I and II. Realizing less extent of disease in group II, another Kaplan-Meier plot restricted to stage I and II patients showed overlapping survival curves for groups I and II.
Conclusion: Survival during 10-year observation was similar for patients with pulmonary insufficiency treated by wedge resection to that of patients receiving standard resection in this single-institution consecutive cohort.