Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial.

Abstract

BACKGROUND:

Little prospective, multiinstitutional data exist regarding the morbidity and mortality after major pulmonary resections for lung cancer or whether a mediastinal lymph node dissection increases morbidity and mortality.

METHODS:

Prospectively collected 30-day postoperative data was analyzed from 1,111 patients undergoing pulmonary resection who were enrolled from July 1999 to February 2004 in a randomized trial comparing lymph node sampling versus mediastinal lymph node dissection for early stage lung cancer.

RESULTS:

Of the 1,111 patients randomized, 1,023 were included in the analysis. Median age was 68 years (range, 23 to 89 years); 52% were men. Lobectomy was performed in 766 (75%) and pneumonectomy in 42 (4%). Pathologic stage was IA in 424 (42%), IB in 418 (41%), IIA in 37 (4%), IIB in 97 (9%), and III in 45 (5%). Lymph node sampling was performed in 498 patients and lymph node dissection in 525. Operative mortality was 2.0% (10 of 498) for lymph node sampling and 0.76% (4 of 525) for lymph node dissection. Complications occurred in 38% of patients in each group. Lymph node dissection had a longer median operative time and greater total chest tube drainage (15 minutes, 121 mL, respectively). There was no difference in the median hospitalization, which was 6 days in each group (p = 0.404).

CONCLUSIONS:

Complete mediastinal lymphadenectomy adds little morbidity to a pulmonary resection for lung cancer. These data from a current, multiinstitutional cohort of patients who underwent a major pulmonary resection constitute a new baseline with which to compare results in the future.

• Authors: Mark S Allen, Gail E Darling, Taine T V Pechet, John D Mitchell, James E Herndon 2nd, Rodney J Landreneau, Richard I Inculet, David R Jones, Bryan F Meyers, David H Harpole, Joe B Putnam Jr, Valerie W Rusch, ACOSOG Z0030 Study Group
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 81 Issue 3 Pg. 1013-9; discussion 1019-20 (Mar 2006) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 16488712 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Topics

• Adult
• Aged
• Aged, 80 and over
• Drainage (adverse effects)
• Female
• Humans
• Lung Neoplasms (mortality, pathology, surgery)
• Male
• Middle Aged
• Morbidity
• Neoplasm Staging
• Patient Selection
• Postoperative Complications (classification, epidemiology)
• Survival Analysis
• Thoracic Surgical Procedures (adverse effects)