Sublobar Resection: A Movement from the Lung Cancer Study Group

Blasberg, Justin D.; Pass, Harvey I.; Donington, Jessica S.

doi:10.1097/jto.0b013e3181e77604

Cited by 115 publications

(72 citation statements)

References 75 publications

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“…However, some studies reported that survival after sublobar resection for small-sized (≤2 cm) NSCLC is similar to that of lobectomy (9). Further, randomized trials including lung cancer with solid features are currently ongoing to validate these conclusions (CALGB 140503, JCOG 0802) (10,11).…”

Section: Original Articlementioning

confidence: 99%

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

et al. 2016

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Background: Sublobar resection is considered controversial for non-small cell lung cancer (NSCLC) presenting as a solid-predominant nodule. The aim of this study was to identify risk factors related to recurrence in small-sized NSCLC presenting as a solid-predominant nodule. Methods: We conducted a retrospective chart review of 118 patients who were treated for clinical N0 NSCLC sized ≤2 cm and who underwent sublobar resection with clear resection margins. We assigned them to two groups according to radiologic features: ground glass opacity (GGO)-predominant tumor and solidpredominant tumor. Clinicopathological characteristics and survival were analyzed in both groups. Risk factors for recurrence were analyzed in the solid-predominant tumor group. Results: Seventy-three patients had a GGO-predominant tumor, and 45 patients had a solid-predominant tumor. Five-year recurrence-free survival (RFS) in the solid-predominant tumor and GGO-predominant tumor groups was 64.9% and 95.5%, respectively. A multivariate analysis was performed to determine factors associated with recurrence after sublobar resection in the solid-predominant tumor group; it indicated that SUVmax [hazard ratio (HR) =1.482, 95% confidence interval (CI): 1.123-1.956, P=0.005] and histologic types other than adenocarcinoma (squamous cell carcinoma, HR =8.789, 95% CI: 1.572-49.134, P=0.013; other types, HR =53.569, 95% CI: 2.616-1096.849, P=0.010) were significant risk factors for recurrence.Conclusions: Risk factors in solid-predominant tumors sized ≤2 cm after sublobar resection are a high SUVmax and histologic types other than adenocarcinoma. Thus, lobectomy should be considered for solidpredominant NSCLC sized ≤2 cm with a high SUVmax or non-adenocarcinoma types.

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Section: Original Articlementioning

confidence: 99%

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

et al. 2016

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“…Two recent reviews of sublobar resection concluded that wellselected use of sublobar resection, especially for pure AIS of f2 cm, yields comparable survival and recurrence rates to lobectomy [23,24]. In this way, sublobar resection is generally considered acceptable for GGO lesions or adenocarcinomas with minimal invasion.…”

Section: Sublobar (Limited) Resection For Lung Cancermentioning

confidence: 99%

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Asamura²,

et al. 2011

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A new adenocarcinoma classification was recently introduced by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS). A distinction is made between pre-invasive lesions, and minimally invasive and invasive adenocarcinoma. The confusing term ''bronchioloalveolar carcinoma'' is not used any more and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma.Due to a renewed interest in screen-detected nodules and early-stage lung cancers of ,2 cm, this classification also has profound implications for thoracic surgeons.In this article, surgical topics are discussed: the role of a minimally invasive approach, especially video-assisted thoracic surgery, limited resection for early-stage lung cancer, the extent of lymph node dissection, the accuracy of intraoperative frozen section analysis, management of multiple lung nodules and prognostic factors in operated patients. Specific key issues are presented based on the current evidence and areas of surgical uncertainty are defined providing a basis for further studies.Thoracic surgeons will play a major role in the application and global introduction of this new adenocarcinoma classification. The remaining controversies regarding the precise diagnosis and management of early-stage lesions will have to be resolved by multidisciplinary and international collaboration.

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“…19) The Cancer and Leukemia Group B (CALGB) 140503, phase III trial is ongoing to compare the recurrence-free survival of patients with a small tumor less than 2 cm in NSCLC undergoing lobectomy versus sublobar resection. 20) Also, the aim of this study is to compare the results of lobectomy by open thoracotomy to VATS or the results of sublobar resection by open thoracotomy to VATS. The results of this study will provide more precise and reliable information about the advantages or disadvantages of VATS segementectomy.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Segmentectomy with Intraoperative Evaluation of Sentinel Nodes for Stage I Non-Small Cell Lung Cancer

Moroga

Yamashita

Tokuishi

et al. 2012

Ann Thorac Cardiovasc Surg

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Objectives: Segmentectomy is the treatment of choice for small-sized non-small cell lung cancer (NSCLC); however, it is difficult to decide the surgical procedure because accurate evaluation of hilar lymph node metastasis remains unclear. We here report the outcome of video-assisted thoracic surgery (VATS) segmentectomy with and without the assessment of sentinel nodes. Materials and Methods: Eighty-three patients with stage IA NSCLC underwent VATS segmentectomy between January 2003 and December 2010. Twenty patients underwent indocyanine green fluorescence imaging for sentinel node biopsy (SNB) and 63 did not. Intraoperative real-time quantitative RT-PCR to determine the expression of CK-19 was used for evaluation of metastasis. Perioperative outcome, local recurrence rates and survival were compared in both groups. Results: Sentinel lymph nodes were identified in 16 of 20 patients (80%) with segmentectomy in the SNB group. The false negative rate was 0%. By RT-PCR for CK-19 expression, only one of these patients showed positive sentinel nodes, which indicated isolated tumor cells; however, segmentectomy was not converted to lobectomy. Seven of 63 patients with VATS segementectomy without SNB and none of the SNB group relapsed. In the relapsed patients without SNB, 4 (6.3%) were local recurrences and 3 (4.7%) were distant metastases. Recurrence-free survival rates in both groups were not significantly different because of the short follow-up period of the SNB group. Conclusions: Our study demonstrated that VATS segmentectomy with SNB was useful for deciding intraoperatively to perform segmentectomy with an accurate lymph node status.

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Sublobar Resection: A Movement from the Lung Cancer Study Group

Cited by 115 publications

References 75 publications

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Thoracoscopic Segmentectomy with Intraoperative Evaluation of Sentinel Nodes for Stage I Non-Small Cell Lung Cancer

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