Surgical treatment of bronchogenic carcinoma: the importance of staging in evaluating late survival.

From 1971 to 1980, 1292 patients with lung cancer were admitted to the Hôpital du Sacré-Coeur de Montréal. This diagnosis represented 0.5% of admissions in 1971 and 1.7% in 1980 (240% increase). Only 4% of patients were nonsmokers. Patients ranged in age from 30 to 93 years with a male to female ratio of 5.5 to 1. Of 414 cervical mediastinoscopies carried out for right and left pulmonary tumours, 120 (29%) showed mediastinal lymph-node metastasis (positive biopsy). For 35 left-sided lesions, both cervical and left parasternal mediastinoscopies produced 13 (37%) positive biopsies. For 45 left upper lobe and left hilum tumours, left parasternal mediastinoscopy alone yielded 18 (40%) positive biopsies. Only 297 (23%) of the 1292 patients were considered to have operable lesions and they underwent thoracotomy - 164 (55%) lobectomies, 104 (35%) pneumonectomies, 2 (1%) segmentectomies and 27 (9%) exploratory thoracotomies. The most common postoperative complication was respiratory failure - in 27 cases (9%); there were 12 (4%) bronchopleural fistulas. The operative death rate was 5% - 1.8% for lobectomy, 7.4% for exploratory thoracotomy and 9.6% for pneumonectomy. Causes of death were respiratory failure (60% of the deaths), hemorrhage (13%), cardiac events (13%) and bronchopleural fistula (13%). The overall 5-year survival was 9.2%. For the 297 patients operated on, the survival at 5 and 10 years was 55% and 36% for stage I disease, 30% and 20% for stage II disease and 10% and 8% for stage III disease, respectively. The mean postoperative follow-up was 41.5 months (range from 3.5 to 14 years).(ABSTRACT TRUNCATED AT 250 WORDS)