The surgical treatment of lung cancer: a retrospective analysis of 2004 cases

Abstract

Objective: To summarise the clinical results of surgical treatment of 2004 cases of lung cancer over a period of 33 years and to evaluate the main influencing factors for long-term results.

Methods: 2004 patients treated at our department were included in this study. The pathological classification proposed and revised by WHO in 1982 was used. The TNM (tumour, nodes, and metastasis classification) system of staging proposed and modified by UICC (International Union Against Cancer) in 1987 was followed. Pearson's Chi-square test was used in comparing variables.

Results: There were 1571 men and 433 women, with a man to woman ratio of 3.6:1. The pathological findings were squamous cell carcinoma (944 cases, 47.1%), adenocarcinoma (694, 34.6%), small cell carcinoma (167, 8.3%), adenosquamous cell carcinoma (78, 3.9%), large cell carcinoma (22, 1.1%), alveolar cell carcinoma (17, 0.8%) and miscellaneous carcinoma (82, 4.1%). The p-TNM staging in 1721 resected cases was: stage 0 (2 cases, 0.1%), stage I (860, 50%), stage II (407, 23.6%), staging IIIa (396, 23.0%), stage IIIb (35, 2.0%) and stage IV (21, 1.2%). The overall resection rate was 85.9% (1721/2004) and the complication rate was 15.7% (271/1721). The 30-day mortality was 1.3% (22/1721). The 5-, 10- and 15-year survival rates were 38.8%, 31.6% and 21.8%, respectively. Factors influencing the long-term survival rate included the nature of resection, the mode of resection, presence or absence of lymph gland metastasis, tumour size and degree of extension, pathological type and p-TNM staging.

Conclusions: Surgery is recommended for stage I, II and IIIa non-small cell lung cancer and for stage I and II small cell lung cancer. Meticulous preoperative staging process is important. Bronchoplastic resection is recommended to replace pneumonectomy whenever the conditions are permissible.