The role of routine bronchoscopy for early detection of bronchial stump recurrence of lung cancer-1 year post-surgery

Background: Local recurrence after complete resection (R₀) occur in approximately 20% of patients with stage I disease and in up to 50% with stage III. This study focuses on early detection of stump recurrence by a routine bronchoscopy. Methods: Prospective analysis 1 year after surgery between April 2006 and April 2008. Results: 104 NSCLC patients (age 69.1 ± 9.6 years) participated in the study; 97 underwent lobectomy and 7 pneumonectomy. 61% were stage I, 25% stage II, 10% IIIA, 5% IIIB and 1% stage IV. 66% had N0, 21% had N1 disease, 9% N2 disease and 4% had N3. Bronchoscopy was performed 12.9 ± 3.8 months after surgery. Nine percents had stump polyp, 5 (5%) had a suspicious mucosa. Four of the nine polyps were malignant. Nine other patients had squamous metaplasia and two had squamous dysplasia. Malignant stump recurrence was observed in four cases, all had a stump polyp. All had R₀, but two had short (<1.0 cm) tumor-free bronchial margin, two had N1 disease and two N2 disease. Fisher exact analysis showed short bronchus (p = 0.003), N2 vs. N0-1 (p = 0.012), and N1 vs. N0 (p = 0.011) as significant risk factor for stump recurrence. For stump recurrence, one patient underwent completion pneumonectomy and has no evidence for disease (32.2 months), two patients were treated by chemotherapy and one patient died from pneumonia before therapy. Conclusion: Routine bronchoscopy 1 year after thoracic resection for NSCLC is justified in patients who are at high risk for local recurrence, i.e. short free bronchial margins and N2/N1 disease.