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

Abstract

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.

Clinicopathological features of small‑sized peripheral squamous cell lung cancer

“…This data may reflect the higher malignant potential of sADC, i.e., ADC with micropapillary pattern which is a well-known malignant factor (29,30). Previous studies demonstrated that sublobar resection was a potentially valid surgical option for small-sized tumors (3,4), while the results of large-scale multi-institutional prospective randomized trials are awaited to confirm this (e.g., JCOG0802 and CALGB140503). Furthermore, ADCs with a high proportion of ground glass opacity are classified as minimally invasive or non-invasive ADC (ADC in situ) (31), and complete resection of such minimally invasive or non-invasive ADCs leads to an extremely favorable prognosis (32,33).…”

“…Prior studies that analyzed the relationship between tumor size and prognosis revealed a favorable prognosis for small-sized tumors, especially those ≤2 cm in diameter (1,2). Both randomized and non-randomized studies have revealed good outcomes for patients who underwent sublobar resection of these small-sized tumors (3,4).…”

“…Most previous studies defined peripheral tumors as tumors located in or more peripheral to the fourth branching bronchus (12,13). However, this definition is difficult to use in clinical practice, and several studies of sublobar resection have thus defined peripheral tumors as tumors located within the outer third of the lung field on preoperative computed tomography (3,4), which is an easier clinical definition. However, no study has reported on the use of this definition to compare the clinicopathological and prognostic features of peripheral SCC and peripheral adenocarcinoma (ADC).…”

Evaluation of lobar lymph node metastasis in non-small cell lung carcinoma using modified total lesion glycolysis

“…As a future prospect, we believe that our findings can be applied to determine the indication for limited resection and aid surgical decision-making for primary lesions in other lung lobes. In recent years, limited resection is increasingly employed for patients with comorbid conditions, elderly patients, those with poor respiratory function or in patients with early-stage non-small cell lung cancer (17)(18)(19). Limited resection, especially wedge resection, is a less invasive alternative to lobectomy.…”

Is segmentectomy indicative for small-sized non-small cell lung cancer in the basal segments with a small ground-glass opacity component?

“…Nishio et al have reported an association between the C/T on preoperative CT or the segment locations and postoperative locoregional control and/or outcomes in patients with NSCLC of ≤2 cm who underwent intentional extended segmentectomy. Many previous studies have suggested risk factors for postoperative locoregional recurrence and/or poor outcomes after limited resection, such as male sex, severe smoking history, high C/T on preoperative CT, high maximum standardized uptake values on F-18-fluorodeoxyglucose positron emission tomography/ CT, tumor histology other than adenocarcinoma, visceral pleural invasion, and lymphatic permeation (15,18,(20)(21)(22)(23). Limited resection for small-sized NSCLC patients with these risk factors is still controversial.…”