Does the carinal involvement have the same surgical outcome as the main bronchus involvement in patients with non-small
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ORIGINAL ARTICLE
Does the carinal involvement have the same surgical outcome as the main bronchus involvement in patients with non‑small cell lung cancer? Volkan Erdogu1 · Necati Citak2 · Celal Bugra Sezen1 · Yunus Aksoy1 · Selin Onay1 · Yasemin Emetli1 · Cemal Aker1 · Ozkan Saydam1 · Adnan Sayar1 · Muzaffer Metin1 Received: 6 July 2020 / Accepted: 30 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective Carinal and main bronchus involvement were compared in terms of the survival of patients with N0-1 non-small cell lung cancer (NSCLC). Methods Sixty-six NSCLC patients who underwent complete surgical carinal resection/reconstruction (Carina group) and complete resection because of main bronchus involvement (Main Bronchus group) between 2006 and 2016 were retrospectively analyzed. The Carina group included 30 patients and the Main Bronchus group included 36. In the Carina group, conditions other than carinal involvement that rendered patients pathological (p) T4, and in the Main Bronchus group, conditions that would upstage the pT status from pT2 were excluded. Patients with mediastinal lymph node metastases were excluded. Thus, an isolated main bronchial invasion and isolated carinal invasion patient population was tried to be obtained. Results The overall 5-year survival rate was 49.4% (median 61.5 ± 19.9 months). The 5-year survival rates of patients in the Carina group was 49.2% (median 63.3 months), and that of patients in the Main Bronchus group was 46.4% (median 55.9 months). The difference between survival rates was not statistically significant (p = 0.761). The survival rates of pN0 and pN1 patients also did not differ significantly (63.2% vs. 45.5%, p = 0.207). Recurrence was significantly more common in the Main Bronchus group than the Carina group (28.1% vs. 7.1%; p = 0.04). Conclusions Isolated carinal invasion had a comparable outcome to isolated main bronchus invasion in pN0-1 patients with NSCLC who are undergoing anatomical surgical resection. Keywords Carina invasion · TNM staging · Main bronchus involvement · Main bronchus invasion · Lung cancer
Introduction Correct lung cancer staging is important both in terms of appropriate treatment and to predict life expectancy. The first edition of the Tumor-Node-Metastasis (TNM) staging system distinguished main bronchus involvement less than 2 cm from the carina but without invasion of the carina, and involvement of 2 cm or more from the carina. However, * Volkan Erdogu [email protected] 1
Department of Thoracic Surgery, Yedikule Chest Diseases, Thoracic Surgery Training and Research Hospital, SUAM Zeytinburnu/İST, 34188 Istanbul, Turkey
Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
2
the first classification of carinal involvement as T4 was that of the third edition [1, 2]. The 7th edition of TNM classified main bronchus tumors 2 cm or more from the carina as T2, and those less than 2 cm from the carina (but without carinal invasion) as T3. Multivariate analyse
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