Complete resection in lung cancer surgery: proposed definition
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.