Giulio Maurizi1, Antonio D'Andrilli2, Anna Maria Ciccone2, Mohsen Ibrahim2, Claudio Andreetti2, Simone Tierno2, Camilla Poggi2, Cecilia Menna2, Federico Venuta3, Erino Angelo Rendina4. 1. Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. Electronic address: giuliomaurizi@libero.it. 2. Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. 3. Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy; Lorillard-Spencer-Cenci Foundation, Rome, Italy. 4. Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Lorillard-Spencer-Cenci Foundation, Rome, Italy.
Abstract
BACKGROUND: The relationship between the free margin distance and the recurrence rate and overall survival after R0 wedge resection for non-small cell lung cancer (NSCLC) is still not clear. We retrospectively evaluated the long-term oncologic outcome of patients who had undergone wedge resection for NSCLC to assess the prognostic effect of margin distance in this setting. METHODS: Between 2003 and 2013, 243 consecutive patients with a functional contraindication to major lung resection underwent wedge resection with systematic lymph node dissection for clinical stage I NSCLC. The study enrolled 182 patients with pathologic stage I and R0 resection and divided them into three subgroups according to margin distance of less than 1 cm (n = 30), 1 to 2 cm (n = 80), and more than 2 cm (n = 72). RESULTS: The histologic assessment was adenocarcinoma in 112 patients, squamous cell in 30, and other in 40. Postoperative morbidity was 18.7%, and postoperative mortality was 1.1%. The median follow-up was 31 months (range, 2 to 133 months). The locoregional (lung parenchyma, hilum, mediastinum) recurrence rate was 26.4% (n = 48). The distant recurrence rate was 11% (n = 20). Overall 5-year survival was 70.4%. Disease-free 5-year survival was 51.7%. There was no statistical difference in locoregional (p = 0.9) and distant (p = 0.3) recurrence rate and no difference in overall survival (p = 0.07) when the three groups were compared. CONCLUSIONS: Wedge resection is a viable option for the surgical treatment of stage I NSCLC when lobectomy is contraindicated. The distance between the tumor and the parenchymal suture margin does not influence recurrence or the survival rate when an R0 resection is achieved.
BACKGROUND: The relationship between the free margin distance and the recurrence rate and overall survival after R0 wedge resection for non-small cell lung cancer (NSCLC) is still not clear. We retrospectively evaluated the long-term oncologic outcome of patients who had undergone wedge resection for NSCLC to assess the prognostic effect of margin distance in this setting. METHODS: Between 2003 and 2013, 243 consecutive patients with a functional contraindication to major lung resection underwent wedge resection with systematic lymph node dissection for clinical stage I NSCLC. The study enrolled 182 patients with pathologic stage I and R0 resection and divided them into three subgroups according to margin distance of less than 1 cm (n = 30), 1 to 2 cm (n = 80), and more than 2 cm (n = 72). RESULTS: The histologic assessment was adenocarcinoma in 112 patients, squamous cell in 30, and other in 40. Postoperative morbidity was 18.7%, and postoperative mortality was 1.1%. The median follow-up was 31 months (range, 2 to 133 months). The locoregional (lung parenchyma, hilum, mediastinum) recurrence rate was 26.4% (n = 48). The distant recurrence rate was 11% (n = 20). Overall 5-year survival was 70.4%. Disease-free 5-year survival was 51.7%. There was no statistical difference in locoregional (p = 0.9) and distant (p = 0.3) recurrence rate and no difference in overall survival (p = 0.07) when the three groups were compared. CONCLUSIONS: Wedge resection is a viable option for the surgical treatment of stage I NSCLC when lobectomy is contraindicated. The distance between the tumor and the parenchymal suture margin does not influence recurrence or the survival rate when an R0 resection is achieved.
Authors: Frank C Detterbeck; Vincent J Mase; Andrew X Li; Ulas Kumbasar; Brett C Bade; Henry S Park; Roy H Decker; David C Madoff; Gavitt A Woodard; Whitney S Brandt; Justin D Blasberg Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005
Authors: Scott Sauer; Damon R Reed; Michael Ihnat; Robert E Hurst; David Warshawsky; Dalit Barkan Journal: Front Oncol Date: 2021-04-27 Impact factor: 6.244