Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non–small cell lung cancer

Mohiuddin, Kamran; Haneuse, Sebastien; Sofer, Tamar; Gill, Ritu R.; Jaklitsch, Michael T.; Colson, Yolonda L.; Wee, Jon O.; Bueno, Raphael; Mentzer, Steven J.; Sugarbaker, David J.; Swanson, Scott J.

doi:10.1016/j.jtcvs.2013.11.056

Cited by 136 publications

(105 citation statements)

References 25 publications

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“…Although there is no conclusive definition of the optimal distance (34,35) between a tumor and the nearest section margin, a margin without malignancy is generally considered to be a crucial factor of recurrence and survival. In uniportal VATS, it can be difficult for surgeons to determine how deep their staple applied to obtain free section margins, especially when patients present with deep and non-palpable nodules.…”

Section: Discussionmentioning

confidence: 99%

Nonintubated uniportal thoracoscopic wedge resection for early lung cancer

Tsai¹,

Lin²,

Hsu³

et al. 2017

J. Vis. Surg.

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Section: Discussionmentioning

confidence: 99%

Nonintubated uniportal thoracoscopic wedge resection for early lung cancer

Tsai¹,

Lin²,

Hsu³

et al. 2017

J. Vis. Surg.

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“…In contrast, Mohiuddin et al [27] after reviewing 497 non-biased adult patients who had undergone wedge resections for small (less than 2 cm) NSCLC reported that the overall unadjusted 1 and 2 year local recurrence rates were 5.7% and 11.0%, respectively. However, from the adjusted analyses, an increased margin-distance was significantly associated with a lower risk of local recurrence (P = 0.033), and patients with a 10 mm margin-distances had a 45% lower local recurrence risk than those with a 5 mm distance [hazard ratio (HR) 0.55, 95% confidence interval (CI): 0.35-0.86], while beyond 15 mm, no evidence of additional benefit was achieved.…”

Section: [26]mentioning

confidence: 95%

“…[27] However, both Maurizi et al [26] and Mohiuddin et al [27] did not consider surgical margin cytology in their studies.…”

Section: [26]mentioning

confidence: 99%

Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

Sawabata¹,

Kawase²,

Takahashi³

et al. 2017

MIS

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Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related deaths in the world. Therefore, there is a need to intensify treatments of these tumors. Because stage I NSCLC is a nonmetastatic disease, local therapies are indicated, among which surgery is the most commonly deployed strategy. Pulmonary wedge/sublobar resection is therefore discussed in comparison to stereotactic body radiation therapy for stage I lung cancer. Review of retrospective and prospective clinical trials reveal similar outcomes for both strategies, while a multicenter randomized prospective study comparing the efficacy of both therapies is on-going. Because the results of pulmonary wedge/sublobar resection may depend on tumor size, tumor-distance from surgical margin, tumor size-to-margin distance ratio, and margin cytology, prospective studies to evaluate the clinical implications of these factors, so as to inform patient prognostication, are recommended. Key words:Non-small cell lung cancer, wedge resection, sublobar resection, stage I, stereotactic body radiation therapy ABSTRACTArticle history:

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“…Mohiuddin et al reported that margin distance in wedge resection affects local recurrence (12). Therefore, securing a sufficient surgical margin with wedge resection is very important.…”

Section: Current Issues and Measures In The Thoracoscopic Wedge Resecmentioning

confidence: 99%

Thoracoscopic wedge resection and segmentectomy for small-sized pulmonary nodules

et al. 2017

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With the recent increase in the detection of small-sized lung nodules because of the widespread use of computed tomography (CT), limited resection and minimally invasive surgery are preferred by patients with these lesions. In particular, the detection of nodules that show ground-glass opacity during high-resolution CT has increased. Although lobectomy and lymph node dissection were the standard procedures used for treating lung cancer, limited wedge resection and segmentectomy have become acceptable for treating small-sized lung cancers with nodules showing ground-glass opacity. These limited procedures are widely performed, especially because they can be accomplished thoracoscopically.Furthermore, not only simple segmentectomy but also complex segmentectomy and subsegmentectomy can be performed using three-dimensional (3D)-CT to achieve sufficient resection based on tumor size.There are, however, technical difficulties in thoracoscopic wedge resection and segmentectomy. While it may be curative for small-sized lung nodules, it is sometimes difficult to correctly perform wedge resection when the tumor is not identified intraoperatively. In such cases, we usually perform tumor marking before operating. However, serious complications, such as cerebral air embolism, have been reported. Further, although it can sufficiently resect small-sized lung nodules, segmentectomy is more technically complex than wedge resection. Therefore, we have developed methods to overcome these technical difficulties. By using a hookwire method in a hybrid operating room and 3D-CT simulation for each wedge resection and segmentectomy, we have obtained good outcomes. Limited resection individualized for each patient will continue to evolve with applications such as CT. indeterminate lesions or cure small-sized GGO-dominant lung tumors, because the procedure is simple and easy (5). Although segmentectomy is generally thought to be more complex than wedge resection, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to those of lobectomy for patients with earlystage non-small lung cell cancer (6). Segmentectomy has thus become widely used worldwide (7).If limited resection is possible for a small-sized lung nodule, a thoracoscopic approach is a highly desirable, minimally invasive option (8,9). The thoracoscopic approach has better outcomes than thoracotomy with regard to quality of life and complications, and is preferred over thoracotomy for its advantages of decreased postoperative pain, shortened chest-tube duration, shortened length of hospital stay, faster return to preoperative activity levels, and preserved pulmonary function (8,9).The combination of limited resection and minimally invasive surgery is, therefore, in great demand. In our institute, limited resection is preferred for small-sized GGO-dominant tumors. The aim of this article is to describe the role of limited thoracoscopic wedge resection and segmentectomy for small-sized lung nodules, with reference to recent literature. ...

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Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non–small cell lung cancer

Abstract: In wedge resection for small non-small cell lung cancer, increasing the margin distance ≤15 mm significantly decreased the local recurrence risk, with no evidence of additional benefit beyond 15 mm.

Cited by 136 publications

References 25 publications

Nonintubated uniportal thoracoscopic wedge resection for early lung cancer

Nonintubated uniportal thoracoscopic wedge resection for early lung cancer

Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

Thoracoscopic wedge resection and segmentectomy for small-sized pulmonary nodules

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