Objective : Precise factors determining long-term survival after bronchial sleeve resection for lung cancer remain unclear. Significant prognostic factors were analysed in a series of 145 patients operated on from 1960 to 1989.
Methods : Follow-up in this series was updated until 1999, so a minimum follow-up of 10 years was obtained for surviving patients. One patient was lost to follow-up 4 years after sleeve resection. A univariate and multivariate analysis were performed to determine significant factors related to survival.
Results : For the entire group 5, 10 and 15-year survival rates were 45, 35 and 23%, respectively. Median survival time was 52 ± 10 months.
In univariate analysis there was a significant difference in survival between patients with N0 and N1 or N2 (p = 0.001) disease and also between N1 and N2 disease (p = 0.04). Stage IB yielded a better survival than IIIA (p = 0.001) or IIIB (p = 0.003) disease. Significance was also found between T2 and T4 (p = 0.02) and between T3 and T4 disease (p = 0.01).
Female sex gave a survival advantage (p = 0.03). Carcinoid tumors had a far better prognosis than squamous cell carcinoma or adenocarcinoma (p = 0.0001). Other factors, such as side and location of the tumor, compromised lung function, completion pneumonectomy and development of a second primary lung cancer were not significant.
A Cox multivariate analysis showed only nodal stage (p < 0.0001) and patient age (p = 0.0007) to be significant factors in relation to survival. The relative risk associated with N0 disease was 0.32, N1 0.57 and N2 5.41.
Conclusions : Long-term results after bronchial sleeve resection are mainly influenced by nodal stage and patient age. Adjuvant treatment should be considered in case of N1 or N2 disease as most of these patients die of distant metastases.