Elsevier

The Annals of Thoracic Surgery

Volume 84, Issue 5, November 2007, Pages 1675-1679
The Annals of Thoracic Surgery

Original article
General thoracic
Sublobar Resection for Patients With Peripheral Small Adenocarcinomas of the Lung: Surgical Outcome is Associated With Features on Computed Tomographic Imaging

https://doi.org/10.1016/j.athoracsur.2007.03.015Get rights and content

Background

Sublobar resection for peripheral small adenocarcinomas of the lung remains controversial. We studied the feasibility of deciding whether to perform limited pulmonary resection on the basis of preoperative images obtained by high-resolution computed tomography.

Methods

A total of 123 patients with adenocarcinoma of the lung underwent sublobar resection of clinical T1N0M0 tumors measuring 2 cm or less in diameter on high-resolution computed tomography. Patients with multiple lung cancers or a history of lung cancer or other malignancies were excluded. The remaining 63 patients were studied. All tumors were classified as “air-containing type” or “solid-density type” according to the tumor shadow disappearance rate on high-resolution computed tomography. We evaluated the surgical outcomes of sublobar resection with respect to findings on high-resolution computed tomography images.

Results

Forty-six patients had air-containing type tumors (tumor shadow disappearance rate ≥50%), and 17 had solid-density type tumors (tumor shadow disappearance rate <50%). Forty-nine wedge resections and 14 segmentectomies were performed. Wedge resection was the most common procedure in patients with air-containing type tumors. Pathologically, air-containing type tumors comprised 38 bronchioloalveolar carcinomas and 8 nonbronchioloalveolar carcinomas. No patient with air-containing type tumors had recurrence after a median follow-up of 70 months (range, 21 to 133 months). Overall and relapse-free survival rates at 5 years were 95% and 100%, respectively, in patients with air-containing type tumors, as compared with 69% and 57%, respectively, in those with solid-density type tumors.

Conclusions

Sublobar resection might be an acceptable procedure for the treatment of small air-containing type adenocarcinomas of the lung on preoperative high-resolution computed tomography. However, our findings must be confirmed in larger, multicenter studies.

Section snippets

Patients and Methods

Our ethics committee was informed of this retrospective study and gave their approval for publication. Individual patient consent was waived by the chairman of the ethics committee. Between July 1992 and October 2004, 329 patients with adenocarcinoma of the lung underwent complete resection of clinical T1 N0 M0 tumors measuring 2 cm or less in diameter on HRCT at our hospital. Preoperative evaluation included a detailed history and physical examination, chest radiography, CT of the chest and

Results

The 63 patients ranged in age from 43 to 84 years (median, 67 years) and comprised 28 men and 35 women. The clinical and pathologic findings of the patients according to tumor type on HRCT are summarized in Table 1. Eleven air-containing type tumors showed pure ground-glass opacity (GGO), defined as a hazy increase in lung attenuation without obscuring the underlying vascular markings on HRCT. Among the patients with air-containing type tumors, intentional sublobar resection was performed in 39

Comment

Lobectomy remains the standard operation for small non–small-cell lung cancers. The role of intentional sublobar resection for these tumors should be evaluated in well-designed clinical trials. At present, there are two possible indications for intentional sublobar resection. The first is for clinically diagnosed very early lung cancers, usually defined as clinical T1 N0 M0 tumors 2 cm or less in diameter that are located in the periphery of the lung. Because lymph node metastasis accompanies

References (18)

There are more references available in the full text version of this article.

Cited by (79)

  • Imaging Phenotyping Using Radiomics to Predict Micropapillary Pattern within Lung Adenocarcinoma

    2017, Journal of Thoracic Oncology
    Citation Excerpt :

    Detailed information about textural features is included in Supplementary Tables 1 and 2. The tumor disappearance rate (TDR) was calculated as follows: [1 – (Tumor area of the mediastinal windows/Tumor area of the lung windows)] × 100.11 As for fludeoxyglucose F18 positron emission tomography (PET) analysis, maximum standardized uptake value (SUVmax) was extracted from the primary tumor in the PET images for each patient.

View all citing articles on Scopus
View full text