Table 1:
Best evidence papers
| Author, date, journal and country Study type (level of evidence) |
Patient group | Outcomes | Key results | Comments |
|---|---|---|---|---|
| Rami-Porta et al. (2005), Eur J Cardiothorac Surg, Spain [2] Retrospective cohort study (level 3) |
580 NSCLC patients who underwent incomplete resection or exploratory/diagnostic thoracotomy only From a multicentre study of 2754 NSCLC surgical patients from 1993–1997 |
Operative mortality 5-year survival and median survival of those that survived surgery |
Incomplete resection (n = 256): operative survival 88%, 5-year survival 20%, median survival 19.10 months Exploratory thoracotomy (n = 223): operative survival 93%, 5-year survival 5%, median survival 10.82 months Diagnostic thoracotomy (n = 12): operative survival 94%, 5-year survival 11%, median survival 7.67 months |
Improved survival in incomplete resection vs exploratory thoracotomy (P < 0.0001), and incomplete resection vs diagnostic thoracotomy (P = 0.0023) Did not distinguish between R1/R2 residual, and ‘incomplete resection’ included residual nodal disease No statistically significant difference in operative mortality |
| Ichinose et al. (1993), Lung Cancer, Japan [4] Retrospective cohort study (level 3) |
29 patients from single centre with NSCLC, who underwent incomplete resection or exploratory thoracotomy between 1972 and 1988 From a series of 98 patients at National Kyushu Cancer Centre Patients all fit for pneumonectomy, complete resection not possible because of the extent of primary tumour All the patients had postop radiotherapy |
Median survival, 3-year survival | Incomplete resection (n = 9): 3-year survival 11.1%, median survival 6.5 months Exploratory thoracotomy (n = 20): 3-year survival 10%, median survival 17 months |
No statistically significant difference in survival between the two groups (P = 0.27) No distinction made between R1 and R2 disease Excluded patients with microscopic residual at bronchial stump Nodal status: incomplete resection N0 (n = 5), N2 (n = 4) Exploratory thoracotomy N0 (n = 7), N2 (n = 11), unknown (n = 2) |
| Yang et al. (2009), Ann Thorac Surg, China [6] Retrospective cohort study (level 3) |
40 patients T4 NSCLC with mediastinal involvement From a study of 146 patients at Sun Yat-sen University Cancer Center from 1997 to 2008 |
Median survival, 3-year survival | Incomplete (R2) resection (n = 9): 3-year survival 0%, median survival 12.0 months Incomplete (R1) resection (n = 16): 3-year survival 0%, median survival 19.2 months Exploratory thoracotomy (n = 15): 3-year survival 0%, median survival 5.3 months |
No significant survival difference between R2 resection and exploratory thoracotomy (P = 0.376) Significantly better survival with R1 resection than exploratory thoracotomy (P = 0.010) No data on nodal status |
| Duque et al. (2005), Chest, Spain [3] Retrospective cohort study (level 3) |
From the same set of 2754 patients from multiple centres as Rami-Porta et al. (2005) [2] Separate analysis of patients with stage IIIB NSCLC was done |
5-year survival | Incomplete resection (n = 51): 5-year survival 19.6% Exploratory thoracotomy (n = 186): 5-year survival 4.8% |
Data extracted from other statistics, no significance analysis No data on R1/R2 resection or nodal status |
| Martini et al. (1994), Ann Thorac Surg, USA [8] Retrospective cohort study (level 3) |
From a set of 102 NSCLC patients with N0 or N1, T3 or T4 disease involving the mediastinum From Memorial Sloan-Kettering Cancer Centre from 1974 to 1992 |
5-year survival | Incomplete resection (n = 25): 5-year survival 12% Exploratory thoracotomy (n = 31): 5-year survival 0% |
No data on R1/R2 resection or nodal status No statistical significance analysis All patients having exploratory thoracotomy and then having incomplete resection had interstitial implantation of radioactive source |
| Hara et al. (1984), J Surg Oncol, Japan [5] Retrospective cohort study (level 3) |
282 patients with stage III bronchogenic carcinoma From National Kyushu Cancer centre, 1972–1981 Nearly all patients received postop radiotherapy or chemotherapy |
3-year survival, 5-year survival, median survival | Exploratory thoracotomy (n = 52): 5-year survival 0%, median survival 11 months Incomplete resection (n = 64): 3-year survival 7%, 5-year survival 0%, median 15 months Inoperable (n = 113): median survival 13 months |
No significant difference in survival between the three groups (P-values not given) Included residual nodal disease in definition of incomplete resection In incomplete resection, survival was significantly better in patients with T3N0 disease than in T3N1 and T3N2 disease (P < 0.01) |
| Downey et al. (1999), Ann Thorac Surg, USA [7] Retrospective cohort study (level 3) |
From a set of 334 patients with NSCLC with chest wall involvement From Memorial Sloan-Kettering Cancer Centre between 1974 and 1993 No metastases but variable nodal status |
Median survival, 5-year survival | Incomplete resection (n = 94): 5-year survival 4%, median survival 9 months (range 1–165) Exploratory thoracotomy (n = 65): 5-year survival 0%, median survival 7 months (range 1–70) |
No distinction between R1 and R2 disease in survival data No distinction between nodal status 21 patients had R1 resection, with no brachytherapy 73 had R2 resection (75% had brachytherapy implants) 65 had no resection (86% had brachytherapy implants) |
| Burt et al. (1987), Surg Clin North Am, USA [9] Retrospective cohort study (level 3) |
176 patients with NSCLC invading the mediastinum From Memorial Sloan-Kettering Cancer Centre 1974–1984 Patients had resection and/or thoracotomy with iodine-125 or iridium 129 implantation |
3-year survival, 5-year survival | Incomplete resection with implantation (n = 33): 3-year survival 22%, 5-year survival 22% Incomplete resection without implantation (n = 42): 3-year survival 0% No resection, implantation only (n = 101): 3-year survival 9%, 5-year survival 0% |
No distinction between R1 and R2 disease No statistical analysis Full text article not available |
| Ratto et al. (1988), Ital J Surg Sci, Italy [10] Retrospective cohort study (level 3) |
75 patients with stage III NSCLC | 2-year survival | Incomplete resection (n = 25): 2-year survival 14% Exploratory thoracotomy (n = 25): 2-year survival 7% No surgery (n = 25): 2-year survival 9% |
No information about nodal status or R1/R2 status Control group with no surgery; the authors concluded that neither incomplete resection nor exploratory thoracotomy improved survival Postop chemo and radiotherapy given |