The prognostic significance of skip mediastinal lymphatic metastasis in resected non-small cell lung cancer

Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbul, Istanbul, Turkey
European Journal of Cardio-Thoracic Surgery (Impact Factor: 3.3). 04/2002; 21(3):595. DOI: 10.1016/S1010-7940(01)01135-6
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    ABSTRACT: Objectives : Treatment of persistent N2 disease following induction therapy remains controversial. The aim of this study was to evaluate the operative risk and long term survival in patients who underwent pneumonectomy. Methods : We included 153 patients who underwent pneumonectomy from January 1999 to July 2005 ; 28 patients (18.3 %) had persistent N2 disease following induction therapy (group 1), 32 patients (20.9 %) were pN0 or pN1 following induction chemotherapy (group 2), and 93 patients (60.8 %) with stage pN2 underwent primary surgery (group 3). Endpoints were 30 day and 90 day mortality, major complications, rough survival and survival free of disease. Statistical analysis was made with SPSS 11.5 software. Results : Thez 3 groups were similar for demographics (age, gender, side of operation, type of chemotherapy, smoking, comorbidities such as coronary artery disease, diabetes, COPD). 30-day mortality was 10.7% in group 1, 3.1% in group 2 (p=0.257), and 4.3% in group 3 (p=0.201) ; 90-day mortality was 10.7% in group 1, 12.5% in group 2 (p=0.577), and 9.7% in group 3 (p=0.558). Major complication rate was similar. 5-year survival was 32.2% (median = 28 months ; 95% CI : 7-43) in group 1, 34.8% (median = 27 months ; 95% CI : 7-47) in group 2 (p=0.685), and 12.4% (median = 15 months ; 95% CI : 11-19) in group 3 (p=0.127). 5-year survival without recurrence was 43.3% (median = 18 months ; 95% CI : 0-41) in group 1, 48.3% (median = 47 months) in group 2 (p=0.480), and 23.3% (median = 12 months ; 95% CI : 9-15) in group 3 (p=0.336). Conclusion : Our results suggest that pneumonectomy is a valuable option in patients with persistant N2 disease after induction chemotherapy. We did not observe any increased operative risk, and 5-year survival was satisfactory.
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    ABSTRACT: A 26-year-old male patient who presented with symptoms of end stage cardiac failure as a result of dilated cardiomyopathy, had an orthotopic cardiac transplantation. A comprehensive cardiac rehabilitation programme was provided to him and he was introduced to a sport (tennis). The exercise training programme progressed from low intensity training to high intensity programme over a period of 15 months. A cardio-pulmonary exercise test done 22 months after surgery suggested that he was able to achieve the aerobic capacity comparable to that of a normal South Indian subject. He participated successfully in the World Transplant Games in Sydney and returned safely. This suggests that after a proper cardiac rehabilitation programme, patients undergoing heart transplantation can achieve normal physiological responses to lead a normal active life.
    Full-text · Article · Oct 2006 · The Indian journal of chest diseases & allied sciences
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