| Objective To explore the influence of surgical procedures on the non-small cell lung cancer patients, that have exceeded 70 years old. By comparing the long-term survival of two patients with different T stages after accepting the above mentioned above, the status and role of pulmonary wedge resection in the treatment of elderly patients with stage I non-small cell lung cancer were analyzed.Methods A retrospective analysis was conducted on the 230 stage I non-small cell lung cancer patients'(age>70) clinical data, which were collected between January 2000 and January 2006. The pulmonary wedge resection in patients with male 56 cases, female 27 cases; lobectomy in patients with male 101 cases, female 46 cases. Pulmonary wedge resection patients the lesions located in the left lung in 17 cases, 15 cases of left lung, right lung in 27 cases, in the right lung in 4 cases, right lower lung in 20 cases; corresponding pulmonary lobectomy patients whose tumors located in the left lung in 21 cases, 42 cases of left lower lung, right upper lung 48 cases, right lung in 9 cases, right lung in 27 cases. Accept pulmonary wedge resection for postoperative pathological findings of 42 cases of adenocarcinoma, 25 cases of squamous cell carcinoma, 9 cases with adenosquamous carcinoma, other kinds of malignant tumor in 7 cases; lobectomy patients with pathological findings in 73 cases of adenocarcinoma, 47 cases of squamous cell carcinoma, 18 cases of adenosquamous carcinoma, other kinds of malignant tumor in 9 cases. In TNM staging, 93 patients with IA patients(pulmonary wedge resection in 32 cases, 61 cases of pneumonectomy), 137 cases of stage I B patients(pulmonary wedge resection in 51 cases, lobectomy in 86 cases).Also, we performed the analysis of its prognosis and the clinical factors that could affect the prognosis. Using SPSS 17 software for statistical analysis, measurement data to(+ S), the use of t test or analysis of variance compared to count data using chi square test. Survival by the Kaplan Meier method calculation, using log rank test method of single factor analysis of the variables and the survival rate significantly. Multivariate analysis was performed using the Cox proportional hazards model, to P < 0.05, the difference was statistically significance. Follow-up the use of outpatient review, telephone and letters, survival time from the date of surgery, on a month to month as a unit, follow-up of the termination date is January 1, 2011 or date of death, lost to follow-up or deadline was regarded as censored data.Results The results of univariate analysis indicated that smoking history, T grading, surgical procedures, lymphadenectomy were the influencing factors of prognosis(P<0.05). Multivariate analysis showed that surgical procedures, T grading and lymphadenectomy were the independent factors that could affect the prognosis of stage I NSCLC patients that older than 70(P<0.05). The five-year survival rate of wedge resection and pulmonary lobectomy was 42.2% and 50.3% respectively, and it was statistically significant between them(P<0.05). Stratified analysis of stage I non-small cell lung cancer patients in T1 a indicated that it had no statistically significance between the five-year overall survival rate of wedge resection and pulmonary lobectomy(51.9% and 53.3% respectively, P>0.05). Compared with pulmonary lobectomy, wedge resection had shorter operative time(P=0.035), less postoperative bleeding(P=0.031) and shorter postoperative hospital stay(P=0.045).Conclusions Pulmonary lobectomy followed by systematic lymphadenectomy was still the preferred surgical procedure for the non-small cell lung cancer patients that older than 70; Pulmonary wedge resection with surgical trauma and postoperative recovery after the fast, complication rate was low and the patients survival advantages of high quality, and can get a lobectomy and resection of the same short-term survival rate. For more than 70 years old of stage I NSCLC patients, pulmonary wedge resection surgery is the effective treatment;for the patients in T1 a, wedge resection could got the comparable long-term benefits with pulmonary lobectomy, also, it had less lung tissue loss. For the elder patients with poor lung function, wedge resection was preferred. |
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