Effectiveness of Intraoperative Pulmonary Wedge Resection of Tumor Site Before Lobectomy for Early Lung Adenocarcinoma

Abstract

Background/Aim: Circulating tumor cells (CTCs) are tumor cells shed from tumor sites and circulate in the peripheral blood. CTCs can be a surrogate biomarker of recurrence and prognosis. Because surgical manipulation could promote CTCs, it is important to reduce CTCs during surgery. This study aimed to evaluate the effectiveness of intraoperative wedge resection of the tumor site before lobectomy. Patients and Methods: A total of 297 resected stage I lung adenocarcinoma patients were retrospectively reviewed. Patients were divided into two groups: Wedge and Non-Wedge. Recurrence-free survival (RFS) curves were plotted using the Kaplan-Meier method. Cox regression analyses were used to evaluate the hazard ratio (HR) with the endpoint RFS. Results: The 5-year RFS rates were 92.9% and 85.5%, in Wedge and Non-Wedge groups, respectively (p=0.006). Wedge resection was an independent factor associated with RFS (HR=0.342, 95%CI=0.141-0.830, p=0.018). Conclusion: Wedge resection before lobectomy for lung adenocarcinoma patients can improve RFS rates.

Effect of intraoperative needle biopsy on the survival of nonsmall cell lung cancer patients: a propensity score matching analysis

“…Huang et al reported that preoperative biopsy was an independent factor influencing overall recurrence and that it worsened the disease-free survival of patients with stage I adenocarcinoma, as determined by multivariate analysis adjusted by PSM [19]. As mentioned, Yasukawa et al reported that intraoperative partial pulmonary resection before lobectomy decreased the recurrence rate and improved RFS of earlystage lung adenocarcinoma patients [16].…”

“…Wei et al showed that the vein-first ligating technique was better than the artery-first technique for lobectomy, in terms of prognosis and reduction of CTCs, for patients with NSCLC [15]. Yasukawa et al found that partial resection before lobectomy decreases the recurrence rate and improves RFS of patients with early-stage lung adenocarcinoma [16]. Partial resection was used to create a tumor-free environment before In comparing the preoperative and intraoperative biopsies, Taniguchi et al reported that a preoperative biopsy did not worsen prognosis relative to a lung resection biopsy in patients with cTanyN0M0 NSCLC, as revealed by multivariate analysis [17].…”

Tumor resection reduced circulating tumor cell dissemination

“…The CTCs positive in hepatocellular carcinoma (HCC) patients after liver resection has a significantly higher risk of recurrence compared to those who were CTCs negative, and the concept of CTCs being potential seeds of metastatic dissemination [17]. There are studies demonstrated that the surgical resection may increase the dissemination of tumor cells into the circulation [13,14]. So, it is critical to know CTCs counts into the blood stream that dissemination from the primary tumor through surgical intervention to predict recurrence and metastasis, or judgement if chemotherapy is necessary after surgical treatment.…”

Essential updates 2021/2022: Surgical outcomes of oligometastasis in pancreatic ductal adenocarcinoma

“…Lung resection has been reported to be safe with minimal complications, and mortality has rarely been reported 35,36 . Most patients underwent wedge resection, while lobectomy was performed only in a few cases 36,37 …”

“…Furuse et al 40 reported that patients with oligometastasis with a solitary or a few lesions, especially in the lung, can benefit from surgery. The median OS after initial therapy and lung resection was reported to range from 52 to 121 months and from 27 to 47 months, respectively 36,37,39,41,42 . Thomas et al 41 reported that the median OS after initial treatment was significantly longer for patients with lung recurrence than those with liver recurrence among patients with surgery (92.3 vs. 32.5 months).…”