Fate of patients with residual tumour at the bronchial resection margin

Abstract

The presence of microscopic deposits of tumour cells at the bronchialresection margin (BRM) may adversely affect the prognosis of patients.Residual tumour cells were identified at the BRM in 40 (5.4%) of 735patients who had been operated on for non-small cell lung carcinoma(NSCLC). The extent of disease was stage I in 7 (17.5%), stage II in 21(52.5%), stage IIIa in 10 (25%) and stage IIIb in 2 (5%) patients.Malignant cells were found to have infiltrated the submucosal lymphatics in5 (12.5%) cases and the peribronchial tissue in the remaining 35 (87.5%).Fifteen (37.5%) patients received adjuvant radiotherapy (RT). Recurrence ofthe disease was diagnosed in 29 (72.5%) patients after a median of 17months (range 3-111). The recurrence was local in 17 (59%) and distant in12 (41%). The 5-year overall actuarial survival rate was 21.6% and was notaffected by RT (P = NS). Only patients with stage IIIa disease and apositive bronchial stump had a significantly reduced 5-year survival ratecompared to those with a negative stump, 0% vs 17% (P < 0.001). Tumourcells at the resection margin did not affect the survival in this cohortexcept those with stage IIIa disease, and the addition of adjuvant RT didnot significantly affect its recurrence in patients with NSCLC.