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Lobectomy versus sublobar resection for small (2 cm or less) non-small cell lung cancers.

BACKGROUND: We evaluated a cohort of patients who underwent resection for small (2 cm or less) non-small cell lung cancer (NSCLC) to determine if there is an association between extent of resection (lobar versus sublobar resection) and local recurrence or survival.

METHODS: We reviewed 468 consecutive patients who underwent resection for small NSCLC at our institution between 2000 and 2005. We excluded patients who had neoadjuvant therapy, active noncutaneous malignancies, pure bronchioalveolar carcinoma, lymph node (n = 53) or distant metastases at diagnosis, or multicentric cancers. Clinicopathologic data, recurrence, and vital status as of June 15, 2010, were retrieved. Overall and recurrence-free survival from surgery rates were assessed.

RESULTS: Two hundred thirty-eight patients underwent resection for primary solitary small NSCLC. Lobectomy (n = 84) was associated with longer overall (p = 0.0027) and recurrence-free (p = 0.0496) survival. Patients who underwent sublobar resection were older (p < 0.0001) and had worse pulmonary function (p < 0.0014). While there was a trend toward increased rate of local recurrence for sublobar resection (16% versus 8%, p = 0.1117), there was no difference in distant recurrence. Moreover, when lymph nodes were sampled with sublobar resection, local recurrence rate and overall and recurrence-free survival distributions were similar to those for lobectomy.

CONCLUSIONS: Sublobar resection is reasonable in older patients with limited cardiopulmonary function. For healthy patients, however, lobectomy remains the standard therapy, with sublobar resection with lymph node sampling representing an alternative to consider. These findings support continued effort to conduct a randomized trial of lobar versus sublobar resection, such as CALGB 140503.

Positron emission tomography-computed tomography for postoperative surveillance in non-small cell lung cancer.

BACKGROUND: The role of positron emission tomography-computed tomography (PET-CT) for the staging of non-small cell lung cancer (NSCLC) has been well documented, whereas its role for postoperative surveillance after the curative resection of this cancer has not. We prospectively implemented PET-CT in our surveillance protocol for recurrence of NSCLC and investigated its effectiveness as compared with that of conventional methods.

METHODS: The cohort for our study of PET-CT in detecting recurrence of NSCLC consisted of 358 patients who had undergone complete resection of NSCLC between January 2005 and June 2008. After resection of their tumors, all of the patients were routinely examined at the thoracic surgical outpatient clinic at 3-month intervals for 2 years and after this at 6 month intervals for next 3 years. Careful patient interviews, physical examinations, chest roentgenography, and measurements of the serum carcinoembryonic antigen level were done at each visit. Contrast-enhanced chest CT was done at 6-month intervals, and PET-CT was done annually for 5 years after resection of NSCLC.

RESULTS: Recurrences were detected in 111 patients (31%). In 60 of these patients, recurrence was detected with conventional methods, and in the remaining 51 patients recurrences were detected with simultaneous PET-CT and chest CT. Among these latter patients, recurrence was evident in both the chest CT and PET-CT scans of 26 patients (51.0%), and in the PET-CT scans alone of 19 patients (37.3%). Five lung lesions (2 small, 1 subpleural, 1 cavitary, and 1 nodule of ground-glass opacity) and 1 pancreatic metastasis were detected with chest CT only.

CONCLUSIONS: When the two methods were used simultaneously, PET-CT seemed superior to chest CT for detecting recurrences of NSCLC. However, because PET-CT may fail to detect small or hypometabolic recurrences of NSCLC, we recommend that it be done on an annual basis along with low-dose chest CT.

Improving rates of surgery for lung cancer.

As two Seminars in this week's issue show, surgery has an important part to play in the management of early-stage lung cancer. Surgical lung resection offers good rates of cure for patients who have stage I or II non-small-cell lung cancer and immediate surgery is beneficial for those with small-cell lung cancer with very limited stage disease.
In the past, the UK's surgical resection rates have remained lower than those achieved in Europe and the USA, but a new audit suggests that this situation is changing. The UK's second National Thoracic Surgery Activity and Outcomes Report shows that the number of patients with lung cancer undergoing surgery has increased by 60% in the past 4 years, while post operative mortality has halved during the past decade from 3·8% to 2·1%.
This improvement has been due in part to thoracic surgery becoming more defined as a specialty (as opposed to cardiothoracic surgery), resulting in an increase in surgeons in this area. However, there is still a need to boost numbers. The audit notes that, if the rate of operations across the country matched the best performing areas, then at least an additional 1000 lives could be saved each year. Furthermore, current evidence supports the expansion of surgery as part of multimodality management of patients with N2 disease (metastasis in ipsilateral mediastinal or subcarinal lymph nodes or both), and, as diagnostic techniques improve, more cancers will be detected at an operable stage...

Adults With Aspirin-Exacerbated Respiratory Disease More Likely Inhaled Environmental Tobacco Smoke As Kids

A first-of-its-kind study is giving smokers one more reason to quit as a New Year's resolution. The study, which will be published in the January 2012 issue of Annals of Allergy, Asthma & Immunology has shown that adults with aspirin-exacerbated respiratory disease are three times more likely to have been exposed to second-hand smoke during their childhood compared with those without the condition.

Approximately 10% of asthma sufferers and one third of asthmatics with chronic sinus inflammation are affected by aspirin-exacerbated respiratory disease (AERD)...

Pathology and virology findings in cases of fatal influenza A H1N1 virus infection in 2009–2010

Conclusions:  The pulmonary findings are similar to those described in past pandemics. Secondary fungal and viral infections, which have not been reported previously, were noted. Although the number of cases in this study is small, the findings reinforce the notion that changes in extrapulmonary organs are attributable to multiorgan dysfunction syndrome rather than a viral cytopathic effect, and that there is no transplacental transmission of virus.

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