Article
Limited resection of stage I primary lung cancer by 1318-nm Nd-YAG laser in high-risk geriatric patients
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Published: | March 22, 2010 |
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Background: Recent case-matched studies demonstrate that stage I non-small cell lung cancer (NSCLC) in functionally inoperable patients can be treated by limited resection approaches without compromising the oncological result. The recently introduced 1318-nm Nd-YAG laser enables the highly selective and parenchyma-saving excision of pulmonary lesions, and was thus originally designed for the removal of multiple lung metastases and more central lesions. In this prospective study, we are evaluating the mid-term results after local resection of stage I primary NSCLC by laser knife in high-risk geriatric patients with significant co-morbidities and a predicted postoperative FEV1 (ppoFEV1) less than 40%.
Material and Methods: Between 2001 and 2005, 15 high-risk geriatric patients underwent local resection of stage I NSCLC by 1318-nm Nd-YAG laser. We assessed their postoperative course, tumor recurrence, and survival by statistical means.
Results: Postoperative mortality was zero. Three patients (20%) had minor surgical complications in the postoperative period (persistent air leak, delayed wound healing). The postoperative respiratory function was unchanged as compared to the pre-operative value. The median follow-up was 13.7 months (range 4–25 months). Recurrence rates (6.6%) and actuarial 2-year survival (68%) were comparable to standard lobectomy results, as reported in the literature. None of the four deaths observed during the follow-up period was cancer-related (cardiorespiratory disease).
Conclusion: The 1318-nm Nd-YAG laser enables the resection of stage I NSCLC in geriatric high-risk patients under complete preservation of respiratory function, but without jeopardizing the oncological outcome.