Lung cancer patients showing pure ground-glass opacity on computed tomography are good candidates for wedge resection
Introduction
The present standard operation for primary lung cancer is considered to be lobectomy with systematic lymphadenectomy. However, suitability of limited resection has been examined by several investigators. Outcome of segmentectomy first was reported in a large number of patients by Jensik et al. [1] in the 1970s. They performed segmentectomy for 168 stage I peripheral lung cancers, obtaining a survival rate of 53% at 5 years after surgery; this survival rate was comparable to that with lobectomy. However, a later study [2] from the same institution demonstrated a higher recurrence rate with segmentectomy than with lobectomy in stage I lung cancer. In that study, the rate of locoregional recurrence was 22.7% (15/66) after segmentectomy versus 4.9% (5/103) after lobectomy. A randomized controlled trial comparing limited resection (segment or wedge) with lobectomy for T1N0 non-small cell lung cancer (NSCLC) was carried out by the Lung Cancer Study Group [3] beginning in the 1980s.That study clearly found outcome with limited resection to be inferior to that with lobectomy, in terms of both survival and locoregional recurrence. Since then, limited resection for stage IA lung cancer generally has been avoided, except for patients with impaired cardiopulmonary function.
On the other hand, small cancers with diameters less than 1 cm frequently have been found in the periphery of the lung since introduction of mass screening by computed tomography (CT) in recent years [4], [5], [6]. Most such small cancers are not detectable in chest radiopraphs; by CT, they show ground-glass opacity (GGO) [7]. Most of them are diagnosed pathologically as localized bronchioloalveolar carcinoma or as atypical adenomatous hyperplasia (AAH) [8], [9], a precancerous lesion. Further, development of video-assisted thoracoscopic surgery (VATS) can permit relatively noninvasive wedge resection of small lung nodules in a short operating time, which is particularly important for poor-risk patients [10], [11], [12]. However, indications for sublobular resection and curability of these small lung cancers by such procedures still are controversial. Avoidance of excessive surgery for small lung cancers detected by increasingly wide spread mass CT screening will become an important issue. We therefore sought to identify the clinicopathologic characteristics of lung cancers suitable for wedge resection by retrospectively analyzing outcomes of patients with primary NSCLC removed by sublobular resection without systematic dissection of lymph nodes.
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Patients
We analyzed consecutive 100 patients with primary NSCLC initially treated at our hospital from January 1981 to December 2002 by wedge resection or segmentectomy without systematic dissection of lymph nodes. Patients who underwent lobectomy for primary lung cancer prior sublobular resection or who underwent sublobular resection as a palliative operation for advanced disease were excluded from the present analyses. As 2051 patients with NSCLC underwent surgery during this period, those undergoing
Results
Clinicopathologic features of the patients are shown in Table 1. Twenty-seven tumors (27%) showed PGGO by high-resolution CT (Fig. 1). These all were diagnosed histologically as localized bronchioloalveolar carcinoma in resection specimens, and none of these showed microscopic blood vessel or lymph vessel invasion (Fig. 2). Seventy-three tumors (73%) that included solid components of varying extent by CT were defined as non-PGGO tumors (Fig. 3). Patients with PGGO tumors were significantly
Discussion
Screening for lung cancer using chest CT is becoming more prevalent, and small peripheral lung cancers are being detected more frequently. Most of these lung cancers detected by chest CT but not by radiography are approximately 10 mm or less in diameter; histologically, they are well differentiated, bronchioloalveolar-type adenocarcinomas. The typical appearance of these lesions by high-resolution CT is so-called GGO, which resembles focal fibrosis or inflammatory change. In contrast, small lung
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2016, Lung CancerCitation Excerpt :It is possible that management of NSNs may be different among different countries, institutions and surgeons and this may have played a role in the decision to perform surgery. Among the 24 studies, 22 [2,6,7,15–33] included only institutions in Asia (618 of 704 patients), one study included institutions in 8 countries, predominantly in the United States, but also in Europe, Japan and China [1] (84 of 704 patients) and one study [34] included 2 of the 704 cases from Germany. In 3 studies [16,18,25] accounting for a total of 48(7%) resected cases, only patients who underwent limited resection were included.