Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study

Niigata Cancer Center Hospital, Niahi-niigata, Niigata, Japan
The Journal of thoracic and cardiovascular surgery (Impact Factor: 4.17). 11/2006; 132(4):769-75. DOI: 10.1016/j.jtcvs.2006.02.063
Source: PubMed


At present, even when early-stage, small-sized non-small cell lung cancers are being increasingly detected, lesser resection has not become the treatment of choice. We sought to compare sublobar resection (segmentectomy or wedge resection) with lobar resection to test which one is the appropriate procedure for such lesions.
From 1992 to 2001, a nonrandomized study was performed in 3 institutes for patients with a peripheral cT1N0M0 non-small cell lung cancer of 2 cm or less who were able to tolerate a lobectomy. The results of the sublobar resection group enrolled preoperatively (n = 305) were compared with those of the lobar resection group (n = 262).
Except for distribution of tumor location, there were no significant differences in any variable, patient characteristics, curability, pathologic stage, morbidity, or recurrence rate. Median follow-up was more than 5 years. Disease-free and overall survivals were similar in both groups with 5-year survivals of 85.9% and 89.6% for the sublobar resection group and 83.4% and 89.1% for the lobar resection group, respectively. Multivariate analysis confirmed that the recurrence rate and prognosis associated with sublobar resection were not inferior to those obtained with lobar resection. Postoperative lung function was significantly better in patients who underwent sublobar resection.
Sublobar resection should be considered as an alternative for stage IA non-small cell lung cancers 2 cm or less, even in low-risk patients. These results could lay the foundation for starting randomized controlled trials anew, which would bring great changes of lung cancer surgery in this era of early detection of lung cancer.

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Available from: Masahiko Higashiyama, Apr 09, 2015
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    • "Segmentectomy consists of not only the removal of the TBS but also the dissection of lymph nodes around the TBS bronchi, hilum and mediastinum. Unlike wedge resection, segmentectomy enables assessment of lymph node metastasis [10] [11] [12]. Considerable attention should be placed on the N1 lymph node which is frequent site of metastases and it is hard to be dissected than N2. "
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    ABSTRACT: To investigate lymph node metastasis especially the intrapulmonary node in clinical IA peripheral lung cancer patients to evaluate the indications for lung segmentectomy in lymph node level. Patients (n=292) with clinical stage IA peripheral lung cancer received radical lobectomy at our department between October 2013 and July 2014 were enrolled in our study. Lymph nodes were obtained during routine surgical procedures while segmental lymph nodes were dissected from the resected lobe for pathological examination. New classification for pulmonary adenocarcinoma with each histologic component was also analyzed. The percentage of patients found to have no lymph node metastasis was 90.4% (264/292). Tumor size on computed tomography and tumor consistency were independent predictors for lymph node metastasis. Tumor with a dominant ground-glass opacity (GGO) component was a good predictor for lymph node metastasis (p<0.001). Metastasis was more common in larger tumors (p<0.001), but there was non-tumor bearing segment metastasis even in tumor less than 1cm. Patients with micropapillary or solid component were correlated with lymph node metastasis (p=0.001 and p=0.009, respectively). The rate of metastasis to the lymph nodes is very low in clinical stage IA peripheral lung cancer patients. Patients with a dominant GGO component on CT might be the suitable candidates for lung segmentectomy because of almost no lymph node metastasis. Careful selection should be made for the patients with tumor size ≤2cm who had metastasized nodes in non-tumor bearing segment when considering segmentectomy. If the resected tumor had micropapillary or solid component, the lobectomy might be considered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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    • "Lungcancerwithoutnodal involvementcanbetreatedwithradiotherapybutsometimes appearstobebenigninspiteofradiologicalsignsofamalignant tumourwithCTorPET.Thus,itisnecessarytotreatsuchlesions bynon-surgicalmodalitiestoexcludeabenignhistology.Thus,we attemptedtoelucidatepredictorsofNNLsforLTswithawide rangeofGGO. JCOGandWJOGconductedtwokindsofclinicaltrialsasto treatmentofclinicalT1alungcancer.Oneofthestudieswasfor invasivelungcancerandtheotherwasfornon-invasiveorminimallyinvasivelungcancer .Invasivelungcancerhasthepotentialfor metastasistothehilarormediastinalnodes,andsurgicalresection ofbothprimarytumourandlymphnodesshouldbethemainstay treatment[6] [16] [17] "
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    ABSTRACT: Peripheral small lung tumours (LTs) showing ground-glass opacity (GGO) tend to be treated without preoperative histological diagnosis due to difficulty in obtaining tissue samples. Exclusion of non-neoplastic lesions (NNLs) is essential when considering non-surgical treatment such as stereotactic radiotherapy. Here, we sought to determine preoperative factors associated with NNLs in peripheral LTs using data from a prospective study that investigated the efficacy of lesser pulmonary resection (JCOG0804/WJOG4507L). The key eligibility criteria of the study were as follows: (i) peripherally located definitive or suspected LC with maximum diameter ≤2 cm and (ii) radiological non-invasive tumour with consolidation/tumour ratio (CTR) of ≤0.25 based on thin-section computed tomography (CT). Among all the resected LTs, incidences of NNL and precancerous lesions were examined. Also, logistic regression analysis was conducted to investigate the predictors of NNL using maximum tumour dimension (≤1 cm/>1 cm) and CTR (0/>0) as an explanatory variable. Between May 2009 and April 2011, 333 patients were prospectively enrolled from 51 institutions into the study. Among 333 patients, 345 LTs were included in the analysis. There were 314 (91.0%) LCs, 17 (4.9%) precancerous lesions and 14 (4.1%) non-cancerous lesions. Maximum tumour dimension ≤1 cm was identified as a significant predictor of NNLs with logistic regression analysis. There were 10 (8.6%) NNLs in 116 LT ≤1 cm, but 4 (1.7%) NNLs in 229 LTs > 1 cm. NNLs were found in only 4.1% of peripheral LTs with GGO. However, when the tumour diameter was ≤1 cm, ∼10% were NNLs, necessitating a histological diagnosis when non-surgical treatment was considered. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    Preview · Article · May 2015 · Interactive Cardiovascular and Thoracic Surgery
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    • "Sublobar resection procedures, such as segmentectomy and wedge resection, have recently been recognized as treatment options for early, small non-small-cell lung cancer (NSCLC), although lobectomy remains the standard treatment procedure for NSCLC patients [1] [2] [3] [4] [5]. In NSCLC cases treated by sublobar resection, intraoperative lymph node (LN) exploration is necessary to avoid incomplete resection, as N1 or N2 disease may be present; 13–17.9% of clinical stage I patients have mediastinal LN involvement [6] [7]. "
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    ABSTRACT: Sublobar resection procedures, such as segmentectomy and wedge resection, can be used for resectable lung cancer when the cancer is small or the condition of the patient is poor. In such cases, intraoperative lymph node (LN) exploration is necessary to avoid incomplete resection of potential N1 or N2 disease. The semi-dry dot-blotting (SDB) method was developed to detect intraoperative LN metastasis as a quick, cost-effective procedure that does not require special technical expertise. This study examined whether SDB can sufficiently identify LN metastasis in lung cancer patients. This study prospectively examined 147 LNs from 50 lung cancer patients who underwent surgery at Nagasaki University Hospital between April 2011 and June 2013. The SDB method uses antigen-antibody reactions with anti-pancytokeratin as the primary antibody and detects cancer cells using chromogen. To identify LN metastases, each LN was examined by the SDB method during surgery along with intraoperative pathological diagnosis (ope-Dx) and permanent pathological diagnosis (permanent-Dx). Compared with permanent-Dx, SDB offered 94.7% sensitivity, 97.7% specificity and 97.2% accuracy, while ope-Dx exhibited 84.2% sensitivity, 100% specificity and 98.0% accuracy. For 3 cases, micrometastases were detected by the SDB method but not by ope-Dx. Three LNs from lobar stations showed pseudo-positive results by the SDB method because of the presence of alveolar epithelium. The SDB method offers acceptably high accuracy in detecting LN metastasis, especially for mediastinal LNs, and represents a potential alternative for the intraoperative diagnosis of LN metastasis, even in the absence of a pathologist. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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