Surgical treatment of lung cancer with adjacent lobe invasion in relation to fissure integrity

Abstract

Background: Tumor with adjacent lobe invasion (T-ALI) is an uncommon condition. Controversy still exists regarding the optimal resection of adjacent lobe invasion, and the prognostic value in relation to fissure integrity at the tumor invasion point. The aims of this paper were to evaluate the prognosis of T-ALI with regard to fissure integrity, and type of resection. Methods: This was a retrospective multicenter study which included all consecutive patients with T-ALI undergoing surgical treatment. Based on radiological, intraoperative and histological findings, T-ALI patients were differentiated into two groups based on whether the fissure was complete (T-ALI-A group) or incomplete (T-ALI-D Group) at the level of tumor invasion point. Clinicopathological features and survival of two study groups were analyzed and compared. Results: Study population included 135 patients, of these 98 (72%) were included into T-ALI-A group, and 37 (38%) into T-ALI-D Group. T-ALI-D patients had better overall survival than T-ALI-A patients (63.9 AE 7.0 vs. 48.9 AE 3.9; respectively, P = 0.01) who presented with a higher incidence of lymph node involvement (35% vs. 4%; P = 0.004), and recurrence rate (43% vs. 16%; P = 0.01). At multivariable analysis, T-ALI-D (P = 0.01), pN0 stage (P = 0.0002), and pT≤5 cm (P = 0.0001) were favorable survival prognostic factors. Conclusions: T-ALI-D presented a better prognosis than T-ALI-A while extent of resection had no effect on survival. Thus, in patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe rather than lobectomy could be indicated. Key points• The extent of resection of adjacent lobe had no effect on survival while T-ALI-D, pN0 stage, and pT≤5 cm were significant prognostic factors. • In patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe could be indicated as an alternative to lobectomy.

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“…However, Haam et al 26 reported the OS and disease‐free survival of ALI‐NSCLC patients were similar to those of T3, and considered the T category should be classified as T3 rather than T2. Andreetti et al 27 differentiated the ALI‐NSCLC as complete and incomplete ALI, based on whether the tumor invaded the adjacent lobe across a complete fissure point, and found the latter provided a better prognosis. Meanwhile, Ohtaki et al 28 divided ALI into the invasion across complete and incomplete fissures, and found the complete fissure was associated with a better prognosis.…”

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“…Andreetti et al analyzed 135 patients with cancers involving the adjacent lobe and also found statistically significant differences between the 5-year survival rates of those patients with direct invasion and with invasion across a complete fissure: 63.9 and 48.9%, respectively ( p = 0.01). In addition, they found significantly higher rates of nodal disease (35 and 4%, p = 0.004) and recurrence (43 and 16%, p = 0.01) among patients with invasion across a complete fissure [ 17 ].…”

“…Data on the topic are scarce, but Okada et al did not find significant differences in the survival of 10 patients who had undergone peumonectomy or bilobectomy and 9 who had undergone lobectomy and sublobar resection of the involved adjacent lobe ( p = 0.9115) [ 15 ]. Andreetti et al did not find statistically significant differences between the 5-year survival rates of pneumonectomy, bilobectomy, lobectomy with segmentectomy, or lobectomy with wedge resection: 39.8, 53.9, 54.3, and 59.8%, respectively ( p = 0.09) [ 17 ]. From these two reports, it seems that a sublobar resection of the involved adjacent lobe could be an adequate oncologic operation.…”