Current perspectives in surgical treatment for lung cancer in China

Abstract

In this article we review clinical data collected in the 1980s and 1990s from 12 495 Chinese patients who had surgery for lung cancer. In these patients the overall resectability rate was 87.2% and the 5-year survival rate was 32.2%. Postoperative complications occurred in 9.6% of cases and the postoperative death rate was 1.5%. Lobectomy and pneumonectomy, with intrathoracic nodal dissection were, and still remain, the principal forms of surgical treatment for lung cancer. The accuracy of evaluating patients by clinical tumour node metastasis (cTNM) staging and pathological TNM (pTNM) staging was affected by limited diagnostic techniques and by a failure to carry out extensive nodal dissection. This was especially true for patients with adenocarcinomas. Although squamous cell carcinoma makes up more than 48.8% of lung cancers in the present study, there is evidence to suggest that adenocarcinoma is becoming the most common type of lung cancer. Its incidence has increased remarkably, particularly in men, in some regions of China. Due to the large number of lung cancer cases which involved lymph node metastasis, we emphasise the value of extensive nodal dissection in improving the survival rate of patients. In addition, in selected patients with stage IIIB or stage IV non-small-cell lung cancer (NSCLC), we found that resection of the trachea, carina, left atrium and superior vena cava as well as the metastatic focus could improve the rate of patient survival. For patients with cancers occurring in the right upper lobe of the lung, with involvement of the lateral tracheal wall and the carina, we found that favourable results could be obtained by tracheal reconstruction using costicartilage with intercostal vascular pedicles. When an end-to-end anastomosis was unable to be done due to the necessary resection of a longer portion of the trachea, a tube made of soft tissue from the chest wall, with an intercostal vascular pedicle containing an internal stent, could be used.