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Surgical outcome of wide wedge resection in poor-risk patients with clinical-N0 non-small cell lung cancer

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Abstract

Objective

Sublobar resection is practically indicated in poor-risk patients compromised cardiopulmonary reserve or for small ground-glass opacity-dominant adenocarcinomas. The aim of this study was to clarify the surgical outcomes of wide wedge resection in poor-risk patients with clinical-N0 non-small cell lung cancers.

Methods

Sixty-two poor-risk patients, who underwent wedge resection for clinical-N0 lung cancer, were retrospectively reviewed. We defined the ratio of the maximum diameter of the consolidation to the maximum tumour diameter as the consolidation-to-tumour ratio using high-resolution computed tomography.

Results

The 5-year overall, recurrence-free, and lung cancer specific survivals of all patients were 56.4, 46.6, and 81.1%, respectively, while other malignancies were frequently found as causes of death. Overall and recurrence-free survivals were favourable in patients with tumour size ≤3 cm, consolidation-to-tumour ratio ≤0.50, solid tumour size ≤1.2 cm, carcinoembryonic antigen level <5.0 ng/mL and adenocarcinoma. Multivariate Cox proportional hazard model revealed that solid tumour size ≤1.2 cm and consolidation-to-tumour ratio ≤0.50 were independent prognostic factors. CT-guided lipiodol marking was applied in 20 patients to identify the tumour location had no recurrence.

Conclusions

Wide wedge resection could be radical treatment option in poor-risk patients with clinical-N0 non-small cell lung cancer, though careful follow-up might be necessary for other malignancies. Patients with solid tumour ≤1.2 cm or ground-glass-dominant lesion are good candidates for wedge resection. CT-guided lipiodol marking is a useful option to identify the location and safe surgical tumour margin in wedge resection.

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References

  1. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409.

    Article  PubMed  Google Scholar 

  2. Asamura H, Hishida T, Suzuki K, Koike T, Nakamura K, Kusumoto M, et al. Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan Clinical Oncology Group 0201. J Thorac Cardiovasc Surg. 2013;146:24–30.

    Article  PubMed  Google Scholar 

  3. De Zoysa MK, Hamed D, Routledge T, Scarci M. Is limited pulmonary resection equivalent to lobectomy for surgical management of stage I non-small-cell lung cancer? Interact Cardiovasc Thorac Surg. 2012;14:816–20.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sihoe AD, Van Schil P. Non-small cell lung cancer: when to offer sublobar resection. Lung Cancer. 2014;86:115–20.

    Article  PubMed  Google Scholar 

  5. Hattori A, Takamochi K, Matsunaga T, Oh S, Suzuki K. Oncological outcomes of sublobar resection for clinical-stage IA high-risk non-small cell lung cancer patients with a radiologically solid appearance on computed tomography. Gen Thorac Cardiovasc Surg. 2016;64:18–24.

    Article  PubMed  Google Scholar 

  6. Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest. 2014;145:66–71.

    Article  PubMed  Google Scholar 

  7. Altorki NK, Yip R, Hanaoka T, Bauer T, Aye R, Kohman L, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg. 2014;147:754–62 (Discussion 62–4).

    Article  PubMed  Google Scholar 

  8. Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Prediction of pathologic node-negative clinical stage IA lung adenocarcinoma for optimal candidates undergoing sublobar resection. J Thoracic Cardiovasc Surg. 2012;144:1365–71.

    Article  Google Scholar 

  9. Miura H, Yamagami T, Tanaka O, Yoshimatsu R, Ichijo Y, Kato D, et al. CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules. Acta Radiol. 2016;57:303–10.

    Article  PubMed  Google Scholar 

  10. Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Neither maximum tumor size nor solid component size is prognostic in part-solid lung cancer: impact of tumor size should be applied exclusively to solid lung cancer. Ann Thorac Surg. 2016;102:407–15.

    Article  PubMed  Google Scholar 

  11. Altoki NK, Kamel MK, Narula N, Ghaly G, Nasar A, Rahouma M, et al. Anatomical segmentectomy and wedge resections are associated with comparable outcomes for patients with small cT1N0 non-small cell lung cancer. J Thorac Oncol. 2016;11:1984–92 (Epub 2016/08/03).

    Article  Google Scholar 

  12. Sienel W, Dango S, Kirschbaum A, Cucuruz B, Horth W, Stremmel C, et al. Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg. 2008;33:728–34.

    Article  PubMed  Google Scholar 

  13. El-Sherif A, Fernando HC, Santos R, Pettiford B, Luketich JD, Close JM, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol. 2007;14:2400–5.

    Article  PubMed  Google Scholar 

  14. Mohiuddin K, Haneuse S, Sofer T, Gill R, Jaklitsch MT, Colson YL, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cancer. J Thorac Cardiovasc Surg. 2014;147:1169–75 (discussion 75–7).

    Article  PubMed  Google Scholar 

  15. Inoue M, Minami M, Sawabata N, Utsumi T, Kadota Y, Shigemura N, et al. Clinical outcome of resected solid-type small-sized c-stage IA non-small cell lung cancer. Eur J Cardiothorac Surg. 2010;37:1445–9.

    Article  PubMed  Google Scholar 

  16. Tsutani Y, Murakami S, Miyata Y, Nakayama H, Yoshimura M, Okada M. Prediction of lymph node status in clinical stage IA squamous cell carcinoma of the lung. Eur J Cardiothorac Surg. 2015;47:1022–6.

    Article  PubMed  Google Scholar 

  17. Yano M, Yoshida J, Koike T, Kameyama K, Shimamoto A, Nishio W, et al. The outcomes of a limited resection for non-small cell lung cancer based on differences in pathology. World J Surg. 2016;40:2688–97.

    Article  PubMed  Google Scholar 

  18. Suzuki K, Watanabe S, Mizusawa J, Moriya Y, Yoshino I, Tsuboi M, et al. Predictors of non-neoplastic lesions in lung tumours showing ground-glass opacity on thin-section computed tomography based on a multi-institutional prospective study. Interact Cardiovasc Thorac Surg. 2015;21:218–23.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Hiroaki Tsunezuka, Daishiro Kato, Satoru Okada, Tatsuo Furuya, Junichi Shimada & Masayoshi Inoue

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  1. Hiroaki Tsunezuka
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  2. Daishiro Kato
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  3. Satoru Okada
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  4. Tatsuo Furuya
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  5. Junichi Shimada
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  6. Masayoshi Inoue
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Correspondence to Hiroaki Tsunezuka.

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Tsunezuka, H., Kato, D., Okada, S. et al. Surgical outcome of wide wedge resection in poor-risk patients with clinical-N0 non-small cell lung cancer. Gen Thorac Cardiovasc Surg 65, 581–586 (2017). https://doi.org/10.1007/s11748-017-0803-z

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  • DOI: https://doi.org/10.1007/s11748-017-0803-z

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