Inkomplette Resektionen bei Bronchialcarcinom: Morbidität und Prognose

Abstract

Residual tumor (R1) was proven at the proximal bronchial resection margin in 88 (3.6%) of 2464 cases of lung cancer following lung resection and standard lymph node dissection. Postoperative complications (8%) were: fistula of the bronchial suture line (n = 7), bleeding (n = 2) and heart luxation (n = 1). The in-hospital mortality was 16.6%. Causes of death were: bronchial fistula (n = 7), erosion of the pulmonary artery (n = 4), respiratory failure (n = 1), and empyema (n = 1). Forty-three patients received postoperative radiation therapy. Median survival of all patients following incomplete resection was 16 months, compared to 37 months following complete resection (P < 0.001). Length of survival was independent of tumor stage, histology, site of infiltration and postoperative radiation. In conclusion, in resection for lung cancer clear margins should be verified by intraoperative frozen section. In the case of residual tumor at the bronchial resection margin, wider resection is mandatory in stage I and II if the patient meets the functional criteria. Even in stage III a and III b prognosis is significantly better after complete resection than R1-resection; the difference, however, is smaller than in lower stages.

Residual disease at the bronchial stump after curative resection for lung cancer

“…This increase was significantly more pronounced after lobectomy [18]. Others have also reported high incidences of BPF in patients with an R 1 -resection of the bronchial resection margin; however, in these studies, no comparison was made with a control group (R 0 -resections) [9,14,17,33]. Kaiser margin.…”

“…According to stage, survival of patients with stage I and II NSCLC and an R 1 -resection of the bronchial resection margin is significantly worse compared to the stage-corrected survival after radical surgery. In the former, survival is limited due to local recurrence [8,10,14,20,21,40,41]. The negative effect of microscopic residual disease at the bronchial resection margin in stage III NSCLC is less pronounced.…”

“…Survival is even worse in patients with peribronchial residual disease; 1-and 5-year survivals of these patients range between 20-50% and 0-20%, respectively [9,14,15,17,20,21,35]. The poor survival is probably due to the association with mediastinal lymph node involvement in 75-85% of the patients with peribronchial residual disease [14,20,34,35]. According to stage, survival of patients with stage I and II NSCLC and an R 1 -resection of the bronchial resection margin is significantly worse compared to the stage-corrected survival after radical surgery.…”

“…In spite of better preoperative staging with modern imaging methods, the incidence of R 1 -resections of the bronchial resection margin has not decreased during the last decades. Considering the limitation that the definition of an R 1 -resection of the bronchial resection margin is not uniform in literature, the incidence of extra-mucosal, mainly peribronchial microscopic residual disease, is higher as compared to mucosal residual disease [3,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Ergebnisqualität in der onkologischen Chirurgie

“…[3,4,5]. Insbesondere die Bedeutung einer kompletten (radikalen) Resektion des Tumors für das tumorfreie Überleben nach Therapie wurde frühzeitig erkannt und ist seit 1987 in der TNM-Klassifikation der Tumoren als prognostisches Kriterium verankert [3,6]. Die Raten an postoperativen Komplikationen, wie Wundinfektionen, Nahtinsuffizienzen oder notwendigen Revisionsoperationen, sind darüber hinaus auf der Hand liegende Kriterien zur Beurteilung jeder chirurgischen Ergebnisqualität [2,7].…”