Limited Resection for Noninvasive Bronchioloalveolar Carcinoma Diagnosed by Intraoperative Pathologic Examination

Koike, Terumoto; Togashi, K; Shirato, Toru; Sato, Seijiro; Hirahara, Hiroyuki; Sugawara, Masaaki; Oguma, F; Usuda, Hiroyuki; Emura, Iwao

doi:10.1016/j.athoracsur.2009.06.051

Cited by 88 publications

(61 citation statements)

References 28 publications

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“…Multiple studies [1][2][3][4][5][6][7] have shown a 100% 5-year disease-free survival rate, if complete resection is performed for patients with solitary lung adenocarcinoma exhibiting pure lepidic growth (<2-3 cm). Corresponding to adenocarcinoma in situ (AIS) in the International Association for the Study of Lung Cancer/American Thoracic Society/ European Respiratory Society international multidisciplinary classification of lung adenocarcinoma, 8) these tumors are a good indication for sublobar resection.…”

Section: Introductionmentioning

confidence: 99%

Invasiveness and Malignant Potential of Pulmonary Lesions Presenting as Pure Ground-Glass Opacities

Ichinose

Kohno

Fujimori

et al. 2014

Ann Thorac Cardiovasc Surg

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Section: Introductionmentioning

confidence: 99%

Invasiveness and Malignant Potential of Pulmonary Lesions Presenting as Pure Ground-Glass Opacities

Ichinose

Kohno

Fujimori

et al. 2014

Ann Thorac Cardiovasc Surg

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“…Because smaller lesions likely represent an earlier stage and a potentially more curable disease (4), many nonrandomized prospective trials of limited resection of small tumors reported favorable postoperative outcomes (5)(6)(7)(8)(9). Small tumors with the pathological characteristics of adenocarcinoma in situ (AIS) (10) as indicated by ground-glass opacity (GGO) in CT scans, are considered appropriate for limited resection, especially for wedge resection (5,7,9) although a higher locoregional recurrence rate associated with wedge resection when compared to segmentectomy in small NSCLC patients was reported in previous retrospective studies on one hand (11,12).…”

Section: Introductionmentioning

confidence: 99%

Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer

Koike

Sato

et al. 2016

J. Thorac. Dis.

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Background: Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques.Methods: Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV 1 ). Results:The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups.The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV 1 ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV 1 ratios, respectively). Conclusions:A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing largescale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.

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“…The authors stated that they had reviewed 11 thousand citations from which they selected 312 that 'met specified eligibility.' The citations supporting their notion, interestingly, have been presented as series of bronchioloalveolar carcinomas or small adenocarcinomas (o2 cm) [29][30][31][32][33][34][35][36][37][38][39][40][41] (Table 5). In some of these, the actual size of the tumor has been at best vague leaving the impression that some of these lesions may not even qualify as adenocarcinoma, but would rather have to be classified as atypical adenomatous hyperplasia (tumors with lepidic growth and size r0.5 cm).…”

Section: Discussionmentioning

confidence: 98%

Early-stage pulmonary adenocarcinoma (T1N0M0): a clinical, radiological, surgical, and pathological correlation of 104 cases. The MD Anderson Cancer Center Experience

et al. 2013

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The recent proposal for histological subtyping of pulmonary adenocarcinoma by predominant pattern and introduction of the terms adenocarcinoma in situ and minimally invasive adenocarcinoma to replace the term bronchioloalveolar carcinoma by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society has led us to conduct a study of 104 patients with early-stage primary pulmonary adenocarcinoma (T1N0M0), with a view to histological subtype as defined by the new proposal and clinical outcome. None of the clinical parameters of our patient population (type of surgery, age, gender, tumor size, and comorbidities) showed any statistically significant correlation with outcome, except for associated malignancies, which not surprisingly appeared to have a negative impact on survival. In addition, statistical analyses of the histological characteristics to include tumor differentiation and the percentage of a lepidic or bronchioloalveolar component did not show any statistically significant values in terms of survival. Our results failed to show any statistically significant difference of survival between those T1N0M0 adenocarcinomas with a lepidic component and those without, thus questioning the use of terms such as in situ or minimally invasive adenocarcinoma. On the basis of our results, we consider that the outcome for patients with T1N0M0 disease is still best determined by appropriate staging rather than by changes in the pathology nomenclature of adenocarcinoma. The number of deaths due to lung cancer among this group was approximately 158 thousand. Also according to SEER, the age group more commonly affected is individuals between the ages of 55 and 74 years, with a median age at diagnosis of 71 years. Although lung cancer is also seen in younger age groups, people under 45 years of age represent approximately 2% of the total number of cases, while those people between the ages of 45 and 54 years represent approximately 9% of the total number of cases. It is also suggested that factors such as smoking, dietary habits, family history, and chemical exposure to compounds such as asbestos, radon, and silica among many others may play a role in lung cancer pathogenesis. Of all the different types of lung cancer, adenocarcinoma is currently the most frequent.In an effort to better define clinical behavior regarding small size adenocarcinomas, various studies have used different ways to address this issue.

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Limited Resection for Noninvasive Bronchioloalveolar Carcinoma Diagnosed by Intraoperative Pathologic Examination

Cited by 88 publications

References 28 publications

Invasiveness and Malignant Potential of Pulmonary Lesions Presenting as Pure Ground-Glass Opacities

Invasiveness and Malignant Potential of Pulmonary Lesions Presenting as Pure Ground-Glass Opacities

Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer

Early-stage pulmonary adenocarcinoma (T1N0M0): a clinical, radiological, surgical, and pathological correlation of 104 cases. The MD Anderson Cancer Center Experience

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