Surgical Evaluation of Squamous Cell Carcinoma of the Lung

Ahn, Byoung Hee; Moon, Hyeong Sun; Na, Kook Joo; Kim, Sang Hyung

Abstract

The frequency or primary lung cancer is increasing compared to other cancer. Complete surgical resection is the most effective method of treatment, but it is limited to only 25 to 30 percent of patients after initial clinical presentation. The survival rate is different by the subtypes of carcinoma, stages, and general condition of patients. The author investigated the survival rate of 87 patients with squamous cell carcinoma of the lung after surgery. Age ranged from 31 to 73 years, with mean 57.13+/-7.15 and 80.5%(70 cases) was initially diagnosed at sixth and seventh decades. Male to female ratio was 8.9:1. Initial complaints were cough with sputum in 78.1%, weight loss in 31.0%, chest pain and discomfort in 29.9%, and hemoptysis in 24.1%. The location of the tumor was right side in 44.8% and left side in 55.2% ; LUL in 39.1%, RLL in 20.7%, LLL in 16.1%, RUL in 14.9% and RML in 9.2%. Stage I was 19.5%, stage II 25.3%, stage IIIa 54.1% and stage IIIb 1.1%. Operative procedures were as follow : pneumonectomy in 52.9%, lobectomy in 47.1%, sleeve upper lobectomy in 4 cases. Single mediastinal lymph node involvement was observed in 17 cases, and multi-level mediastinal lymph node involvement in 23 cases. Lower paratracheal lymph node and subcarinal lymph node were more frequently involved in right side lung cancer, with 8 and 10 cases, respectively and subaortic lymph node was most frequently involved in left side lung cancer with 9 cases. Operative complications were hoarseness, wound infection and chylothorax in 7, 5 and 4 cases, respectively. The operative mortality was 2.2% and the cause of death was pulmonary edema. Postoperative follow-up period ranged from 1 month to 99 months with a mean of 29.95+/-17.21 months. Overall one-year survival rate was 75.1% and five-year survival rate was 29.8%. One-year and five-year survival rates were 93.7% and 52.4% for stage I, 92.2% and 30.5% for stage II, and 61.2% and 17.4% for stage IIIa, respectively. These findings correlate survival rate with tumor size, mediastinal lymph node metastasis and surgical resectability, and long-term survival can be expected with small sized tumor, absent mediastinal lymph node metastasis and complete surgical resection.