Abstract
The standard surgical procedure for resectable non-small cell lung cancer (NSCLC) is a pulmonary lobectomy, while a sublobar resection is done with an expected curative power equivalent to a pulmonary lobectomy or as a limited operation. The incidence of locoregional recurrence is lower after a pulmonary lobectomy than a pulmonary segmentectomy, followed by a pulmonary wedge resection of NSCLC. One of the causes of locoregional recurrence following pulmonary sublobar resection is speculated to be the cancer cells remaining around the surgical margin, thus irradiation of that area may reduce the rate of such recurrence. However, it may also be prevented using an adequate surgical technique that provides a distance from the surgical margin to the tumor that is greater than the size of the tumor, as the possibility of cancer cells in the surgical margin is very low when the margin-tumor distance is sufficient.
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References
Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg. 1992;104:1679–85.
Downey RJ, McCormack P, LoCicero J 3rd. Dissemination of malignant tumors after video-assisted thoracic surgery: a report of twenty-one cases. The Video-Assisted Thoracic Surgery Study Group. J Thorac Cardiovasc Surg. 1996;111:954–60.
Warren WH, Faber LP. Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg. 1994;107:1087–94.
Shapiro M, Weiser TS, Wisnivesky JP, Chin C, Arustamyan M, Swanson SJ. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for small stage I lung cancers. J Thorac Cardiovasc Surg. 2009;137:1388–93.
Lung Cancer Study Group, Ginsberg RJ, Rubenstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg. 1995;60:615–23.
Schuchert MJ, Abbas G, Awais O, Pennathur A, Nason KS, Wilson DO, Siegfried JM, Luketich JD, Landreneau RJ. Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer. Ann Thorac Surg. 2012;93:1780–7.
Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009;27:2553–62.
Jensik RJ, Faber LP, Milloy FJ, Monson DO. Segmental resection for lung cancer: a fifteen-year experience. J Thorac Cardiovasc Surg. 1973;66:563–72.
Schuchert MJ, Pettiford BL, Keeley S, D’Amato TA, Kilic A, Close J, Pennathur A, Santos R, Fernando HC, Landreneau JR, Luketich JD, Landreneau RJ. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg. 2007;84:926–32.
Donahue JM, Morse CR, Wigle DA, Allen MS, Nichols FC, Shen KR, Deschamps C, Cassivi SD. Oncologic efficacy of anatomic segmentectomy in stage IA lung cancer patients with T1a tumors. Ann Thorac Surg. 2012;93:381–7.
Yamashita SI, Tokuishi K, Anami K, Moroga T, Miyawaki M, Chujo M, Yamamoto S, Kawahara K. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg. 2012;42:83–8.
Kodama K, Doi O, Higashiyama M, Yokouchi H. Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study. J Thorac Cardiovasc Surg. 1997;114:347–53.
Okada M, Yoshikawa K, Hatta T, Tsubota N. Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller? Ann Thorac Surg. 2001;71:956–60.
Koike T, Koike T, Yamato Y, Yoshiya K, Toyabe S. Prognostic predictors in non-small cell lung cancer patients undergoing intentional segmentectomy. Ann Thorac Surg. 2012;93(6):1788–94.
Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132:769–75.
Nomori H, Mori T, Ikeda K, Yoshimoto K, Iyama K, Suzuki M. Segmentectomy for selected cT1N0M0 non-small cell lung cancer: a prospective study at a single institute. J Thorac Cardiovasc Surg. 2012;144:87–93.
Nakamura K, Saji H, Nakajima R, Okada M, Asamura H, Shibata T, Nakamura S, Tada H, Tsuboi M. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol. 2010;40(3):271–4.
Blasberg JD, Pass HI, Donington JS. Sublobar resection: a movement from the Lung Cancer Study Group. J Thorac Oncol. 2010;5:1583–93.
Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, Liptay MJ, Bartley S, Boley TM, Keenan RJ, Ferson PF, Weyant RJ, Naunheim KS. Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer. J Thorac Cardiovasc Surg. 1997;113:691–700.
Sawabata N, Maeda H, Matsumura A, Ohta M, Thoracic Surgery Study Group of Osaka University. Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer. Surg Today. 2012;42:238–44.
Sienel W, Stremmel C, Kirschbaum A, Hinterberger L, Stoelben E, Hasse J, Passlick B. Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localisation and width of resection margins—implications for patient selection for segmentectomy. Eur J Cardiothorac Surg. 2007;31:522–7.
Whitson BA, Groth SS, Andrade RS, Mitiek MO, Maddaus MA, D’Cunha J. Invasive adenocarcinoma with bronchoalveolar features: a population-based evaluation of the extent of resection in bronchoalveolar cell carcinoma. J Thorac Cardiovasc Surg. 2012;143:591–600.
El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, Urda SJ, Luketich JD, Landreneau RJ. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg. 2006;82:408–16.
Kato H, Ichinose Y, Ohta M, Hata E, Tsubota N, Tada H, Watanabe Y, Wada H, Tsuboi M, Hamajima N, Japan Lung Cancer Research Group on Postsurgical Adjuvant Chemotherapy. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med. 2004;350:1713–21.
Douillard JY, Tribodet H, Aubert D, Shepherd FA, Rosell R, Ding K, Veillard AS, Seymour L, Le Chevalier T, Spiro S, Stephens R, LACE Collaborative Group. Adjuvant cisplatin and vinorelbine for completely resected non-small cell lung cancer: subgroup analysis of the lung adjuvant cisplatin evaluation. J Thorac Oncol. 2010;5:220–8.
Shennib H, Bogart J, Herndon JE, Kohman L, Keenan R, Green M, Cancer and Leukemia Group B; Eastern Cooperative Oncology Group. Video-assisted wedge resection and local radiotherapy for peripheral lung cancer in high-risk patients: the Cancer and Leukemia Group B (CALGB) 9335, a phase II, multi-institutional cooperative group study. J Thorac Cardiovasc Surg. 2005;129:813–8.
Bogart JA. Definitive radiotherapy for stage I non-small cell lung cancer: ain’t nothing like the real thing? J Thorac Oncol. 2006;1:763–5.
d’Amato TA, Galloway M, Szydlowski G, Chen A, Landreneau RJ. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest. 1998;114:1112–5.
Colonias A, Betler J, Trombetta M, Bigdeli G, Gayou O, Keenan R, Werts ED, Parda DS. Mature follow-up for high-risk stage I non-small-cell lung carcinoma treated with sublobar resection and intraoperative iodine-125 brachytherapy. Int J Radiat Oncol Biol Phys. 2011;79:105–9.
Fernando HC, Landreneau RJ, Mandrekar SJ, Hillman SL, Nichols FC, Meyers B, DiPetrillo TA, Heron D, Jones DR, Daly BD, Starnes SL, Hatter JE, Putnam JB. The impact of adjuvant brachytherapy with sublobar resection on pulmonary function and dyspnea in high-risk patients with operable disease: preliminary results from the American College of Surgeons Oncology Group Z4032 trial. J Thorac Cardiovasc Surg. 2011;142(3):554–62.
Sawabata N, Mori T, Iuchi K, Maeda H, Ohta M, Kuwahara O. Cytologic examination of surgical margin of excised malignant pulmonary tumor: methods and early results. J Thorac Cardiovasc Surg. 1999;117:618–9.
Goldstein NS, Ferkowicz M, Kestin L, Chmielewski GW, Welsh RJ. Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens. Am J Clin Pathol. 2003;120:720–4.
Sawabata N, Matsumura A, Ohota M, Maeda H, Hirano H, Nakagawa K, Thoracic Surgery Study Group of Osaka University. Cytologically malignant margins of wedge resected stage I non-small cell lung cancer. Ann Thorac Surg. 2002;74:1953–7.
Sawabata N, Ohta M, Matsumura A, Nakagawa K, Hirano H, Maeda H. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. Ann Thorac Surg. 2004;77:415–20.
Sawabata N, Karube Y, Umezu H, Tamura M, Seki N, Ishihama H, Honma K, Miyoshi S. Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy. Interact Cardiovasc Thorac Surg. 2008;7:1044–8.
Higashiyama M, Kodama K, Yokouchi H, Takami K, Nakayama T, Horai T. A novel test of the surgical margin in patients with lung cancer undergoing limited surgery: lavage cytologic technique. J Thorac Cardiovasc Surg. 2000;120:412–3.
Masasyesva BG, Tong BC, Brock MV, Pilkington T, Goldenberg D, Sidransky D, Harden S, Westra WH, Califano J. Molecular margin analysis predicts local recurrence after sublobar resection of lung cancer. Int J Cancer. 2005;113:1022–5.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011;6:244–85.
Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol. 2011;6:751–6.
Suzuki K, Yokose T, Yoshida J, Nishimura M, Takahashi K, Nagai K, Nishiwaki Y. Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung. Ann Thorac Surg. 2000;69:893–7.
Asamura H, Suzuki K, Watanabe S, Matsuno Y, Maeshima A, Tsuchiya R. A clinicopathological study of resected subcentimeter lung cancers: a favorable prognosis for ground glass opacity lesions. Ann Thorac Surg. 2003;76:1016–22.
Yamato Y, Tsuchida M, Watanabe T, Aoki T, Koizumi N, Umezu H, Hayashi J. Early results of a prospective study of limited resection for bronchioloalveolar adenocarcinoma of the lung. Ann Thorac Surg. 2001;71:971–4.
Yoshida J, Nagai K, Yokose T, Nishimura M, Kakinuma R, Ohmatsu H, Nishiwaki Y. Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience. J Thorac Cardiovasc Surg. 2005;129:991–6.
Yoshida J, Ishii G, Yokose T, Aokage K, Hishida T, Nishimura M, Onuki T, Noguchi M, Nagai K. Possible delayed cut-end recurrence after limited resection for ground-glass opacity adenocarcinoma, intraoperatively diagnosed as Noguchi type B, in three patients. J Thorac Oncol. 2010;5:546.
Nakao M, Yoshida J, Goto K, Ishii G, Kawase A, Aokage K, Hishida T, Nishimura M, Nagai K. Long-term outcomes of 50 cases of limited-resection trial for pulmonary ground-glass opacity nodules. J Thorac Oncol. 2012;7(10):1563–6.
Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg. 2002;24:27–31.
Koizumi K, Haraguchi S, Hirata T, Hirai K, Mikami I, Fukushima M, Kubokura H, Okada D, Akiyama H, Tanaka S. Video assisted lobectomy in elderly lung cancer patients. Jpn J Thorac Cardiovasc Surg. 2002;50:15–22.
Tatsumi A, Ueda Y. Video-assisted thoracic surgery for lung cancer. Is it a feasible operation for stage I lung cancer? Jpn J Thorac Cardiovasc Surg. 2003;51:646–50.
Shiraishi T, Shirakusa T, Hiratsuka M, Yamamoto M, Iwasaki A. Video-assisted thoracoscopic surgery lobectomy for c-T1N0M0 primary lung cancer: its impact on locoregional control. Ann Thorac Surg. 2006;82:1021–6.
Sakuraba M, Miyamoto H, Oh S, Shimoi K, Sonobe S, Takahashi N, Imanishi K, Sakao Y. Video-assisted thoracoscopic lobectomy vs. conventional lobectomy via open thoracotomy in patients with clinical stage IA non-small cell lung carcinoma. Interact Cardiovasc Thorac Surg. 2007;6:614–7.
Carr SR, Schuchert MJ, Pennathur A, Wilson DO, Siegfried JM, Luketich JD, Landreneau RJ. Impact of tumor size on outcomes after anatomic lung resection for stage 1A non-small cell lung cancer based on the current staging system. J Thorac Cardiovasc Surg. 2012;143:390–7.
Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T. Prospective study of extended segmentectomy for small lung tumors: the final report. Ann Thorac Surg. 2002;73:1055–8.
Keenan RJ, Landreneau RJ, Maley RH Jr, Singh D, Macherey R, Bartley S, Santucci T. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg. 2004;78:228–33.
Errett LE, Wilson J, Chiu RD-J, et al. Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor risk patients. J Thorac Cardiovasc Surg. 1985;90:656–61.
Miller JI, Hatcher CR Jr. Limited resection of bronchogenic carcinoma in the patients with marked impairment of pulmonary function. Ann Thorac Surg. 1987;44:340–3.
Lee W, Daly BD, DiPetrillo TA, Morelli DM, Neuschatz AC, Morr J, Rivard MJ. Limited resection for non-small cell lung cancer: observed local control with implantation of I-125 brachytherapy seeds. Ann Thorac Surg. 2003;75:237–42.
Fernando HC, Santos RS, Benfield JR, Grannis FW, Keenan RJ, Luketich JD, Close JM, Landreneau RJ. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 2005;129:261–7.
Birdas TJ, Koehler RP, Colonias A, Trombetta M, Maley RH Jr, Landreneau RJ, Keenan RJ. Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer. Ann Thorac Surg. 2006;81:434–9.
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Sawabata, N. Locoregional recurrence after pulmonary sublobar resection of non-small cell lung cancer: can it be reduced by considering cancer cells at the surgical margin?. Gen Thorac Cardiovasc Surg 61, 9–16 (2013). https://doi.org/10.1007/s11748-012-0156-6
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DOI: https://doi.org/10.1007/s11748-012-0156-6