Primary Cancer of the Lung

Between April, 1932, and July, 1974,3,808 patients with primary lung cancer were studied and 1,848 underwent resection. Among untreated patients, 95% were dead within a year. Unresected cancer of the lung is so lethal that efforts to streamline surgical management should not be neglected. In good-risk patients with isolated lesions the approach can be direct. If surgical excision is indicated, regardless of a positive or negative sputum cytology, bronchoscopic biopsy, or brush biopsy, such investigations become superfluous. Needle biopsy is also inconclusive and in addition is hazardous. Preoperative investigation should focus on cardiopulmonary reserve more than on ways to obtain tissue for verification. With the passage of time, the extent of resection has become more conservative. The value of palliative resection is now better appreciated in terms of quality of life, its prolongation, and, for some, a possibility for cure. rimary cancer of the lung was rare and always fatal before the early thirties. I t is now common and selectively curable. A dismal P picture, however, has been presented by most publications. They headline low overall cure rates, and even reports on results of mass screening programs are gloomy. During the past decade the majority of papers have focused on palliative programs of irradiation or chemotherapy. They advocate exhaustive attempts to obtain tissue or cells from sputum or by extraction through endoscopic or direct needle aspiration. Many current articles stress the importance of avoiding operation. Our experience suggests that such intervention is necessary not only to establish the existence of the cancer in its early stages, but also to determine its extent in the advanced case. Clinical Material and Methods Over more than four decades, 3,938 patients suspected of having primary malignancy of the lung have been observed and 3,808 have had a tissue diagnosis. The policy of management has largely been influenced by the senior author, and shifts in staff have been minimal: a total of 8 surgeons have been involved. Only histologically verified cases are the subject of this report. All bronchial adenomas, 175 in number, are excluded. The reference background is unique. In the first From the Overholt Thoracic Clinic, New England Baptist and New England Deaconess Hospitals, Presented at the Eleventh Annual Meeting of The Society of Thoracic Surgeons, Montreal, Que., Address reprint requests to Dr. Overholt, Overholt Thoracic Clinic, 135 Francis St., Boston, Boston, Mass. Canada, Jan. 20-22, 1975.