Intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration |
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Authors: | Takehiro Watanabe Akira Okada Takayuki Imakiire Terumoto Koike Tatsuhiko Hirono |
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Institution: | (1) Division of Chest Surgery, Nishi-Niigata Chuo National Hospital, 1-14-1 Masago, 950-2085 Niigata, Japan |
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Abstract: | Objective: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based
on intraoperative pathologic exploration. Methods: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates
for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic
exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection
was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph
node exploration was performed. Results: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up
period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period
after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient.
The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients
with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant
differences in 5-year survival between extended segmentectomy and lobectomy. Conclusions: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration
makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC.
Read at the Fifty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Panel Discussion, Tokyo, November
19–21, 2003. |
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Keywords: | lung cancer intentional limited resection intraoperative pathologic exploration wedge resection extended segmentectomy |
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