Relevance of an intensive postoperative follow-up after surgery for non–small cell lung cancer

doi:10.1016/S0003-4975(00)01731-8

The Annals of Thoracic Surgery

Volume 70, Issue 4, October 2000, Pages 1185-1190

https://doi.org/10.1016/S0003-4975(00)01731-8 Get rights and content

Abstract

Background. Although a minimal follow-up with periodic clinic visits and chest radiographs is usually recommended after complete operation for non–small cell lung cancer, the ideal follow-up has not been defined yet. Objectives of this prospective study were to determine the feasibility of an intensive surveillance program and to analyze its influence on patient survival.

Methods. Follow-up consisted of physical examination and chest roentgenogram every 3 months and fiberoptic bronchoscopy and thoracic computed tomographic scan with sections of the liver and adrenal glands every 6 months. Influence of patient and recurrence characteristics on survival from recurrence was successively analyzed using the log-rank test and a Cox model adjusted for treatment.

Results. Among the 192 eligible patients, recurrence developed in 136 patients (71%) and was asymptomatic in 36 patients (26%). In 35 patients, recurrence was asymptomatic and detected by a scheduled procedure: thoracic computed tomographic scan in 10 (28%) patients and fiberoptic bronchoscopy in 10. Fifteen patients (43%) had a thoracic recurrence treated with curative intent. From the date of recurrence, 3-year survival was 13% in all patients and 31% in asymptomatic patients whose recurrence was detected by a scheduled procedure. Asymptomatic recurrences (p < 0.001), female sex (p < 0.001), performance status 2 or less (p = 0.01), and age 61 years or younger (p = 0.01) were shown to be significantly favorable prognostic factors.

Conclusions. This intensive follow-up is feasible and may improve survival by detecting recurrences after surgery for non–small cell lung cancer at an asymptomatic stage.

Section snippets

Eligibility criteria

All patients of the Respiratory Medicine Department of Besançon who underwent resection for non–small cell lung cancer between January 1980 and December 1993 and whose postoperative care was performed by this department were considered for this study. Patients were eligible if the cancer had been completely resected. Incomplete resections included positive bronchial or pulmonary parenchymal margins and extranodal cancer invasion of mediastinal lymph nodes. Patients who had had a previous

Patient characteristics

Between January 1980 and December 1993, 298 patients who underwent operations for non–small cell lung cancer were monitored by the Chest Disease Department of Besançon. One hundred six patients were not eligible for the following reasons: incomplete resection (76 patients), previous malignancy within the 5 years before operation (16 patients), and death within the 30 days after operation (14 patients). The remaining 192 patients were eligible for the follow-up study.

Characteristics of patients

Comment

Results of the present study demonstrate that this intensive follow-up is feasible, because 83% to 93% of the scheduled procedures were effectively performed. Even fiberoptic bronchoscopy, considered as the most invasive procedure, was accepted by most patients. Patients who were asymptomatic at the time of recurrence were shown to have a significantly longer survival from recurrence than symptomatic patients. Asymptomatic recurrences were more frequently diagnosed by thoracic CT scan and

Acknowledgements

We thank Doctors Claude Prenat, Didier Pernet, Marie-Lise Paquin, Jean Lahourcade, Fabrice Chaussade, and Jean-Louis Cusenier for their cooperation, and Doctor Willard A Fry for having reviewed this paper.

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Original article: general thoracicRelevance of an intensive postoperative follow-up after surgery for non–small cell lung cancer

Abstract

Section snippets

Eligibility criteria

Patient characteristics

Comment

Acknowledgements

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Chest

J Thorac Cardiovasc Surg

Geographic variation in the conduct of patient surveillance after lung cancer surgery

J Clin Oncol

Original article: general thoracic
Relevance of an intensive postoperative follow-up after surgery for non–small cell lung cancer