The Persistent Problem of Local/Regional Failure After Surgical Intervention for Early-Stage Lung Cancer

Background. The goal of the present study was to estimate the rate of local/regional failure (LRF) after definitive surgical intervention for early-stage non-small cell lung cancer (NSCLC), without postoperative radiotherapy, in the era of contemporary imaging and minimally invasive surgical techniques. Methods. Medical records of patients with early-stage NSCLC (pathologic T1-4, N0-1) who underwent lobectomy, sleeve lobectomy, bilobectomy, or pneumonectomy, with or without adjuvant chemotherapy, between 2007 and 2015, were retrospectively reviewed. LRF was defined as recurrence at the ipsilateral lung, bronchial stump, mediastinum, chest wall, or supraclavicular region. The Kaplan-Meier method was used to estimate time to LRF, with patients censored at death, and log-rank tests were used for comparisons. A two-sided p value of less than 0.05 was considered significant. Results. Included were 217 patients (median age, 65 years). Preoperative staging with positron emission tomography/computed tomography was performed in 89% of patients, mediastinoscopy was performed in 42%, and video-assisted thoracoscopic surgery was performed in 51%. At a median follow-up of 36 months (range, 1 to 120 months), the 5-year estimated LRF was 26% (95% confidence interval, 20% to 35%). LRF rates were not significantly different in those with and without staging positron emission tomography/computed tomography (hazard ratio, 1.52; p = 0.43) and those with video-assisted thoracoscopic surgery versus open thoracotomy (hazard ratio, 1.00; p = 0.99). Conclusions. Despite contemporary staging procedures and surgical techniques for early-stage NSCLC, LRF occurs in approximately 1 of 4 patients. The observed rates of LRF are similar to those reported more than a decade ago, suggesting that local/regional control remains a persistent problem. The use of additional local treatments, such as radiotherapy, should be reevaluated to further improve outcomes. (Ann Thorac Surg 2018;106:382-9) (C) 2018 by The Society of Thoracic Surgeons.