Abstract
Background
Local recurrence is a major concern after sublobar resection (SR) of non-small cell lung cancer (NSCLC). We postulate that a large proportion of local recurrence is related to inadequate resection margins. This report analyzes local recurrence after SR of stage I NSCLC. Stratification based on distance of the tumor (<1 cm vs ≥1 cm) to the staple line was performed.
Methods
We reviewed 81 NSCLC patients (44 female) who underwent operation over an 89-month period (January 1997 to June 2004). Mean forced expiratory volume in one second percentiles (FEV1) was 57%. Mean age was 70 (46–86) years. There were 55 wedge and 26 segmental resections. There were 41 tumors with a margin <1 cm and 40 with a margin ≥1 cm. Local recurrence was defined as recurrence within the ipsilateral lung or pulmonary hilum.
Results
There were no perioperative deaths. Mean follow-up was 20 months. Margin distance significantly impacted local recurrence; 6 of 41 patients (14.6%) developed local recurrence in the group with margin less than 1 cm versus 3 of 40 patients (7.5%) in the group with margin equal to or more than 1 cm (P = .04). Of the 41 patients with margins <1 cm, segmentectomy was used in 7 (17%), whereas in the 40 patients with the ≥1 cm margins, segmentectomy was used in 19 (47.5%).
Conclusions
Margin is an important consideration after SR of NSCLC. Wedge resection is frequently associated with margins less than 1 cm and a high risk for locoregional recurrence. Segmentectomy appears to be a better choice of SR when this is chosen as therapy.
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References
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Ann Thorac Surg 1995; 60: 615–623
Landreneau RJ, Sugarbaker DJ, Mack MJ, et al. Wedge resection versus lobectomy for stage I (T1 N0 M0) Non-small cell lung cancer. J Thorac Cardiovasc Surg 1997; 113:691–700
Mountain CF. Revisions in the International System for staging lung cancer. Chest 1997; 111:1710–7
Allen MS, Parirolero PC. Inadequacy, mortality, and thoracoscopy. Ann Thorac Surg 1995; 59:6
Keenan RJ, Landreneau RJ, Maley RH Jr. Singh D, Macherey R, Bartley S, Santucci T. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg 2004; 78(1):228–233
Higashiyama M, Kodama K, Takami K, Higaki N, Nakayama T, Yokouchi H. Intraoperative lavage cytologic analysis of surgical margins in patients undergoing limited surgery for lung cancer. J Thorac Cardiovasc Surg 2003; 125:101–7
Sawabata N, Matsumura A, Ohota M, Maeda H, Hirano H, Nakagawa K, Matsuda H. Cytologically malignant margins of wedge resected stage I Non-small cell lung cancer. Ann Thorac Surg 2002; 74:1953–7
Sawabata N, Ohta M, Matsumura A, Nakagawa K, Hirano H, Maeda H, Matsuda H. Optimal distance of malignant negative margin excision of non-small cell lung cancer: a multicenter prospective study. Ann Thorac Surg 2004; 77(2):415–20
Fell SC, Kirby TJ. Limited pulmonary resection. Thoracic Surgery, 2nd ed. New York: Churchill Livingstone. 2002; 36:1002–4
Lewis RJ. The role of video assisted thoracic surgery for carcinoma of the lung: wedge resection to lobectomy by simultaneous individual stapling. Ann Thorac Surg 1993; 56:762–8
Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Effect of tumor size on prognosis in patients with non-small cell lung cancer: The role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg 2005; 129(1):87–93
Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg 1987; 44:340–3
Shennib H, Bogart JA, Herndon J, et al. Thoracoscopic wedge resection and radiotherapy for T1N0 non-small cell lung cancer (NSCLC) in high risk patients: preliminary analysis of a Cancer and Leukemia Group B and Eastern Cooperative Oncology Group phase II trial (abstract 240). Int J Radiat Oncol Bio Phys 2000; 48(suppl):232
D'Amato TA , Galloway M, Szydlowski G, Chen A, Landreneau RJ. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest 1998; 114:1112–5
Santos R, Colonias A, Parda D, et al. Comparison between sublobar resection and I125 brachytherapy following sublobar resection in high-risk patients with stage I non-small cell cancer. Surgery 2003; 134:691–7
Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2005; 129:261–7
Lee W, Daly BD, DiPetrillo TA, Morelli DA, Neuschatz AC, Morr J, Rivard MJ. Limited resection for non-small cell lung cancer: observed local control with implantation of I125 brachytherapy seeds. Ann Thorac Surg 2003; 75:237–42
Birdas TJ, Koehler RPM, Colonias A, Trombetta Jr. M, Maley RH, Landreneau RJ, Keenan RJ. Sublobar resection with brachytherapy versus lobectomy in stage IB nonsmall cell lung cancer. Ann Thorac Surg 2006; 81:434–8
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El-Sherif, A., Fernando, H.C., Santos, R. et al. Margin and Local Recurrence After Sublobar Resection of Non-Small Cell Lung Cancer. Ann Surg Oncol 14, 2400–2405 (2007). https://doi.org/10.1245/s10434-007-9421-9
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DOI: https://doi.org/10.1245/s10434-007-9421-9