Predictors of recurrence and disease-free survival in patients with completely resected esophageal carcinoma

ObjectiveThe goal of this study was to analyze factors predictive of recurrence and disease-free survival in patients with completely resected esophageal carcinoma.MethodsWe conducted a retrospective review of a prospective database to identify patients with completely resected esophageal carcinoma. Medical records were reviewed. Recurrence rates, time to recurrence, and disease-free survival were analyzed. The Kaplan–Meier method was used for time to event estimation, and multivariate Cox regression models were constructed to analyze factors thought to be significant in determining both freedom from recurrence and disease-free survival.ResultsFrom 1988 to 2009, 465 of 500 patients underwent complete resection for esophageal carcinoma. Median follow-up for living patients was 49 months; 197 patients (42.4%) had recurrence, leading to 175 patients dying of cancer and 22 patients living with recurrent disease. Multivariate regression adjusted for P stage identified the following variables as independent predictors of freedom from recurrence: performance status greater than 0 (hazard ratio [HR], 1.84; 95 confidence interval [CI], 1.35–2.49]; P < .001), poor differentiation (HR, 1.50; CI, 1.12–2.01; P = .006), induction therapy (HR, 1.65; CI, 1.21–2.25]; P = .002), en bloc resection (HR, 0.61; CI, 0.43–0.88; P = .007), and advanced pathologic stages (II/III/IV) (HR, 5.46; CI, 3.05–9.78; P < .001). Independent predictors of disease-free survival adjusted for P stage were performance status greater than 0 (HR, 1.73; CI, 1.34–2.23; P < .001), en bloc resection (HR, 0.63; CI, 0.47–0.84; P = .002), induction therapy (HR, 1.34; CI, 1.02–1.76; P = .033), and advanced pathologic stages (II/III/IV) (HR, 3.16; CI, 2.15–4.65; P < .001).ConclusionsFor patients with completely resected esophageal cancer, independent predictors of improved freedom from recurrence and disease-free survival include good performance status, en bloc resection, and early pathologic stage

Long-term survival and recurrence in patients with resected non–small cell lung cancer 1 cm or less in size

ObjectiveWith the widespread use of computed tomography and the emergence of screening programs, non–small cell lung cancer is increasingly detected in sizes 1 cm or less. We sought to examine the long-term survival and recurrence patterns after resection of these tumors.MethodsWe conducted a retrospective review over a 15-year period to identify patients with surgically resected non–small cell lung cancer measuring 1 cm or less. Medical records were reviewed, and survival data were analyzed by the Kaplan-Meier method.ResultsThere were 83 patients (26 men, 57 women) with a median age of 67 years (range 43-88 years). Median tumor size was 0.90 cm. Lobectomy was performed in 71 patients, bilobectomy in 1, pneumonectomy in 1, segmentectomy in 5, and wedge resection in 5. Postoperative stage was IA in 67 patients, IB in 4, IIA in 1, IIB in 4, IIIA in 2, and IIIB in 5. Median follow-up was 31 months. There was 1 operative death (1.2%). In 5 (31.3%) of the 16 patients with non-IA disease, recurrent cancer developed after resection. No recurrences were observed in the 67 patients with stage IA disease. The 5- and 10-year overall survivals for the entire cohort were 86% and 72%, respectively, and the disease-specific survival was 91% at both time points. For patients with stage IA disease, 5- and 10-year survivals were 94% and 75%, respectively, and the disease-specific survival was 100% at both time points.ConclusionEighty-one percent of patients with resected non–small cell lung cancer measuring 1 cm or less had stage IA disease. After surgical resection, recurrence is rare and long-term survival is excellent

Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: A propensity-matched analysis from the STS database

BackgroundSeveral single-institution series have demonstrated that compared with open thoracotomy, video-assisted thoracoscopic lobectomy may be associated with fewer postoperative complications. In the absence of randomized trials, we queried the Society of Thoracic Surgeons database to compare postoperative mortality and morbidity following open and video-assisted thoracoscopic lobectomy. A propensity-matched analysis using a large national database may enable a more comprehensive comparison of postoperative outcomes.MethodsAll patients having lobectomy as the primary procedure via thoracoscopy or thoracotomy were identified in the Society of Thoracic Surgeons database from 2002 to 2007. After exclusions, 6323 patients were identified: 5042 having thoracotomy, 1281 having thoracoscopy. A propensity analysis was performed, incorporating preoperative variables, and the incidence of postoperative complications was compared.ResultsMatching based on propensity scores produced 1281 patients in each group for analysis of postoperative outcomes. After video-assisted thoracoscopic lobectomy, 945 patients (73.8%) had no complications, compared with 847 patients (65.3%) who had lobectomy via thoracotomy (P < .0001). Compared with open lobectomy, video-assisted thoracoscopic lobectomy was associated with a lower incidence of arrhythmias [n = 93 (7.3%) vs 147 (11.5%); P = .0004], reintubation [n = 18 (1.4%) vs 40 (3.1%); P = .0046], and blood transfusion [n = 31 (2.4%) vs n = 60 (4.7%); P = .0028], as well as a shorter length of stay (4.0 vs 6.0 days; P < .0001) and chest tube duration (3.0 vs 4.0 days; P < .0001). There was no difference in operative mortality between the 2 groups.ConclusionsVideo-assisted thoracoscopic lobectomy is associated with a lower incidence of complications compared with lobectomy via thoracotomy. For appropriate candidates, video-assisted thoracoscopic lobectomy may be the preferred strategy for appropriately selected patients with lung cancer