Elsevier

Lung Cancer

Volume 49, Issue 1, July 2005, Pages 25-33
Lung Cancer

Complete resection in lung cancer surgery: proposed definition

https://doi.org/10.1016/j.lungcan.2005.01.001Get rights and content

Summary

Objective:

To propose an internationally accepted definition of complete resection in lung cancer surgery.

Material and methods:

The International Association for the Study of Lung Cancer (IASLC) Staging Committee created the Complete Resection Subcommittee in 2001 to work on an international definition of complete resection in lung cancer surgery. The previous definitions of complete resection and the rules of the International Union Against Cancer regarding the TNM residual tumor classification, together with a thorough review of the pertinent literature, and the input of the members of the IASLC Staging Committee were considered in order to get an international consensus on the definition of complete resection in lung cancer surgery.

Results:

Complete resection requires all of the following: free resection margins proved microscopically; systematic nodal dissection or lobe-specific systematic nodal dissection; no extracapsular nodal extension of the tumor; and the highest mediastinal node removed must be negative. Whenever there is involvement of resection margins, extracapsular nodal extension, unremoved positive lymph nodes or positive pleural or pericardial effusions, the resection is defined as incomplete. When the resection margins are free and no residual tumor is left, but the resection does not fulfill the criteria for complete resection, there is carcinoma in situ at the bronchial margin or positive pleural lavage cytology, the term uncertain resection is proposed.

Conclusion:

The proposed definitions of complete, incomplete and uncertain resections are clear and reproducible in an international setting to study their prognostic impact prospectively.

Introduction

The Complete Resection Subcommittee (CRS) was created in London during the meeting of the Staging Committee of the International Association for the Study of Lung Cancer (IASLC), on February 24, 2001. The task of the CRS was to prepare a proposal of definition of complete resection. Dr. Robert Ginsberg was appointed Chairman and Dr. Ramón Rami-Porta member of this Subcommittee. The latter assumed the responsibility for the development of the project after Dr. Ginsberg's premature death. An initial proposal was presented at the meeting of the IASLC Staging Committee that took place in London on April 26, 2002. Two subsequent revisions were presented at the meetings of the Staging Committee of the IASLC in Vancouver, BC, Canada, on August 9, 2003, and in Seattle, WA, USA, on June 25, 2004. The present document includes the background information on which the definition of complete resection is based, and all comments made by those members who attended the meetings.

The objective of this document is to propose definitions whose prognostic value can be tested prospectively.

Section snippets

Definitions of complete resection

The basis of all classifications of complete resection is the Union Internationale Contre le Cancer (UICC) residual tumor classification (R classification) which in the R0 category considers the absence of tumor in the primary site, lymph nodes and distant sites [1], [2]. It has been shown in several tumor types, including lung carcinoma, that the UICC definition of “no residual tumor” might not be sufficient, since despite being designated R0 (no detectable residual tumor after the primary

Proposed definitions

Considering the above information, the following definitions are proposed.

Comment

The proposed definition of complete resection takes into account the main points considered by others and incorporates the concept of systematic nodal dissection. In addition, the less extensive nodal dissection, defined as lobe-specific systematic nodal dissection, is in agreement with the recommendation of the UICC for pN0 [37], and with the stricter definition of pN0 disease proposed by others [38]. We hope that others will find this definition to be clear and easy to apply in standard

Acknowledgments

The project of the Staging Committee of the IASLC is kindly sponsored by Lilly.

Angel López-Encuentra, MD and José Luis Duque-Medina, MD, coordinators of the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery, are to be acknowledged for providing updated and unpublished data on the prognostic impact of the different types of resections used by the Group. This information was important for the elaboration of the definitions included in this document.

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    Members listed in the Appendix A.

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