Appropriate Sublobar Resection Choice for Ground Glass Opacity-Dominant Clinical Stage IA Lung Adenocarcinoma

Tsutani, Yasuhiro; Miyata, Yoshihiro; Nakayama, Haruhiko; Okumura, Sakae; Adachi, Shuji; Yoshimura, Masahiro; Okada, Morihito

doi:10.1378/chest.13-1094

Cited by 267 publications

(187 citation statements)

References 22 publications

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“…The factors that influence the surgical choice for elderly patients with stage I lung adenocarcinoma include tumor size, tumor density on CT, pulmonary function and so on (25). AIS or MIA usually presented with GGO nodules, and patients with AIS or MIA had a 5-year survival of approximately 100%; therefore, patients with GGO nodules may be optimal candidates for limited resection.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

et al. 2018

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Background: This study aimed to evaluate the prognostic difference between limited resection and lobectomy among elderly patients with small size lung adenocarcinoma. Methods: A total of 666 patients >65 years old with stage I lung adenocarcinoma and tumor size ≤2 cm were included. The patient survival was evaluated by disease-free survival (DFS) and overall survival (OS). Results: No DFS or OS advantage was found between the lobectomy and wedge resection groups when tumor sizes were ≤1 cm (DFS, P=0.112; OS, P=0.294). The wedge resection group had a significantly worse OS (P=0.041) than that in the lobectomy group when tumor sizes were >1 cm and ≤2 cm. Conclusions: We conclude that wedge resection may be a reasonable surgical choice for elderly patients with tumor sizes ≤1 cm. The International Association Study of Lung Cancer (IASLC), the American Thoracic Society (ATS) and the European Respiratory Society (ERS) proposed a new edition of the lung adenocarcinoma classification system in 2011 (12). It has been effectively used to predict the prognosis of lung adenocarcinoma patients. The classification was established on the most predominant subtype presented: invasive adenocarcinoma with solid (SOL) or micropapillary (MIP) carcinoma, which is associated with a poor survival (13)(14)(15)(16)(17). Both adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have nearly 100% postsurgical survival, and limited resection is appropriate for those patients. However, to date, whether limited resection is adequate for early-stage invasive lung adenocarcinoma patients, especially for patients who are older than 65, has not been thoroughly studied (8). In this study, a large cohort investigation was carried out to determine the correlation between surgical procedures and postoperative survival among elderly lung adenocarcinoma patients with tumor sizes ≤2 cm. Our study may help to design personalized surgical strategies for older patients. Methods Patient cohortThe retrospective study was permitted by the Institutional Review Board of Shanghai Chest Hospital at Shanghai Jiao Tong University and was performed in compliance with the guidelines of clinical research [ethic approval ID: KS(P)1802].We retrospectively reviewed patients who underwent surgical resection at our hospital between January 2009 and March 2015. The inclusion criteria were patients 65 years old or older, presentation of a single lung nodule, the postsurgical pathological specimen examination validated that the tumor size was less than or equal to 2 cm, there was no lymph node invasion, and there was no distant organ metastasis. The exclusion criteria included patients who had a history of malignancy, had multiple nodules, received neoadjuvant chemotherapy AIS or MIA. Invasive adenocarcinoma variants (such as mucinous, enteric or fetal morphologies) were also excluded for low incidence. Finally, this study included a total of 666 patients.In our clinical practice, patients with the following characteristics were treated with limited resect...

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Section: Discussionmentioning

confidence: 99%

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

et al. 2018

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“…The mean tumor size in this highly-selective study is 9.7 mm with mainly GGO-dominant lesions, especially in the NTUH cohort. We only selected sub-centimeter GGO-dominant lesions in which primary lung cancer cannot be excluded for non-intubated single-incision wedge resection as surgical management both for diagnosis and treatment (14). Intraoperative frozen section was routinely performed to ensure the resection margins to be more than 2 cm if it showed primary lung cancer.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with such lesions, preoperative CT-guided dye localization and intraoperative frozen section were routinely performed to ensure satisfactory oncological treatment (13,14).…”

Section: Patient Selectionmentioning

confidence: 99%

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients

et al. 2017

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Background: Non-intubated single-incision procedures are slowly expanding because of high experience and skill required, and stricter selection criteria. The aim of this study is to present the first retrospective two-center series in Taiwan and Spain.Methods: We performed a retrospective analysis of 188 patients undergoing non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS) procedures between July 2013 to November 2015 in two centers in Taiwan (170 patients) and Spain (18 patients) with two different anesthetic methods. Demographic data, clinicopathological features, preoperative tests, and final outcomes were analyzed to compare the outcomes with the two different techniques.Results: Of the 188 patients, 147 (78%) were women, with a mean body mass index (BMI) of 22.7. Of the 196 specimens, 145 (74%) were malignancies with a mean size of 9.7 mm. Wedge resection was performed in 172 patients (91.4%), anatomical segmentectomy with lymphadenectomy in 8 (4.7%), and lobectomy with lymphadenectomy in 5 (2.6%). Three patients (1.6%) required conversion to orotracheal intubation, while 5 patients (2.7%) required additional ports. Complications appeared in 16 patients (8.5%) with air leak as the most frequent in 7 cases (3.7%). Median chest drainage was 1 day, and median postoperative stay was 3 days.There was neither perioperative death nor postoperative readmission.Conclusions: Non-intubated single-incision procedures can be feasible and safe in expert hands and experienced teams, even for anatomical resections. Strict selection criteria, skill and experience are mandatory. Comparative cohorts and randomized trials are needed.

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“…In a study with 239 patients with clinical T1N0M0 stage IA lung adenocarcinoma that had GGO components greater than 50%, only two lymph node metastases were found among 84 patients (2.4%) with GGO-dominant T1b tumors, and none were found among the 155 patients with GGOdominant T1a tumors. The frequency of mediastinal LN metastasis in GGO-dominant tumors was remarkably less compared to that of solid tumors in most cases (12). Haruki et al's study, which focused on the incidence of lymph node metastasis that occurred in 1,923 consecutive patients who underwent pulmonary resection for lung cancer, revealed significant results.…”

Section: Editorialmentioning

confidence: 99%

Mediastinal lymph node resection in stage IA non-small cell lung cancer with small nodule: is it mandatory?

Kim

2017

J. Thorac. Dis.

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Appropriate Sublobar Resection Choice for Ground Glass Opacity-Dominant Clinical Stage IA Lung Adenocarcinoma

Cited by 267 publications

References 22 publications

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients

Mediastinal lymph node resection in stage IA non-small cell lung cancer with small nodule: is it mandatory?

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