J.Jpn. Surg. Soc.. 108(3): 107-112, 2007

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Feature topic

THE VALUE OF LONG-TERM POSTOPERATIVE FOLLOW-UP AFTER CURATIVE RESECTION OF LUNG CANCER AND COMMON PROBLEMS ASSOCIATED WITH IT

This study was conducted to elucidate the real benefit of postoperative long-term surveillance for 10 years in patients who underwent curative resection for pathological stage I lung cancer. In 1995 and 1996, 100 patients with p-stage I lung cancer underwent curative resection. Of those, 20 patients were excluded because they did not comply with the follow-up regimen.
Our follow-up regimen comprised a physical examination including a posterolateral chest radiograph and blood laboratory test every 6 months for up to 2 years, followed by once a year up to 10 years after resection. In addition, CT generally encompassed the lung apices to the lowest edge of the liver and was performed with intravenous contrast once every two years.
As a result, among 80 patients, nine recurrences (11%) and seven metachronous second primary lung cancers (9%) were detected. Of 16 malignancies detected, six underwent curative reoperation The 5-year survival rates after the discovery of recurrence and of second primary lung cancer were 22% and 72%, respectively. The average survival of the six reoperated patients was 226 days longer than that of the remaining patients. For the calculation of the costs per life-year gained (LYG) of our follow-up program, an estimated survival benefit of 226 days was used. Consequently, the costs per LYG were calculated at almost 4,500,000 yen.
In conclusion, the costs per LYG seem to be acceptable in the light of Japanese average annual earnings. In addition, this follow-up regimen seemed to show a clear survival benefit for patients with metachronous second primary lung cancer. However, for patients with lung cancer recurrence, the perceived benefit was nominal.

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