Consistency and controversy of surgical treatment on locally advanced NSCLC
- VernacularTitle:局限性晚期非小细胞肺癌手术治疗的共识和争论
- Author:
Meilin LIAO
- Publication Type:Journal Article
- Keywords:
lung neoplasms;
non-small cell lung cancer;
surgery
- From:
China Oncology
2000;0(06):-
- CountryChina
- Language:Chinese
-
Abstract:
As we know a poor prognosis is seen in locally advanced NSCLC treated with surgery, there have some consistencies and controversies found in a number of surgical studies. Consistency: Incomplete resection of tumor and central T3 tumor have poor 5-yr survival, T3 with N, has a worse long-term survival rate than with N0. Mediastinal lymph node metastasis N2 is known as the most important prognostic factor in stage Ⅲ NSCLC, multiple node stations, location and extra-capsular nodal extension of tumor are unfavorable prognostic indicatiors. Preoperative induction chemotherapy may improve the complete resection and survival of stage M NSCLC, but more multicenter randomized studies are needed to be further study. T4, N, Mb NSCLC are known as having quite a poor prognosis and low resectability. Controversy: Clinical image staging is a noninvasive method to look for intrathoracic lymph node, but it is not as accurate as mediastinoscopy. Post-operative radiotherapy has a lower relapse rate but no benefit to survival. Pre-operative radiotherapy of pancoast tumor has a higher complication rate. 30% of intrathoracic nodes have skip N2 metastasis, thus, careful dissection of all the nodes stations and sample it sent to pathology is necessary. Pneumonectomy is not beneficial to the survival of pN2. Carinaectomy is not suitable for those patients with N1, N2. Malignant pleural effusion is basically a nonsurgical disease.
