Motoyasu Sagawa1,2, Hiroyuki Oizumi1,3, Hiroyuki Suzuki1,4, Hidetaka Uramoto1,5, Katsuo Usuda1,5, Akira Sakurada1,6, Masayuki Chida1,7, Satoshi Shiono1,8, Jiro Abe1,9, Tohru Hasumi1,10, Masami Sato1,11, Nobuyuki Sato1,12, Jotaro Shibuya1,13, Hiroyuki Deguchi1,14, Yoshinori Okada1,6. 1. Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan. 2. Division of Endoscopy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan. 3. Department of Surgery 2, Faculty of Medicine, Yamagata University, Yamagata, Japan. 4. Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan. 5. Division of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan. 6. Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Japan. 7. Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan. 8. Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan. 9. Department of Thoracic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan. 10. Department of Thoracic Surgery, Sendai Medical Center, Sendai, Japan. 11. Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. 12. Department of Thoracic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan. 13. Department of Thoracic Surgery, Iwate Prefectural Isawa Hospital, Mizusawa, Iwate, Japan. 14. Department of General Thoracic Surgery, Iwate Medical University, Morioka, Iwate, Japan.
Abstract
OBJECTIVES: The incidence of small-sized pulmonary adenocarcinomas with ground-glass opacity (GGO) has recently increased, with excellent postoperative prognosis. The limited resection of such cancers has been deemed to be acceptable based on retrospective studies. We conducted a prospective multi-institutional study evaluating the validity of limited resection for small-sized pulmonary adenocarcinoma with GGO. METHODS: The inclusion criteria were 25-80 years of age, no prior treatment, a maximum tumour diameter of 8-20 mm, a GGO ratio of ≥ 80%, clinical T1N0M0, lower 18F-fluorodeoxyglucose accumulation than the mediastinum, resectable by sublobar resection, pulmonary lobectomy tolerable and an intraoperative pathological diagnosis of bronchiloalveolar carcinoma. Wedge resection was preferred, but segmentectomy was permitted. Disease-specific survival and overall survival were analysed. RESULTS: From November 2006 to April 2012, 73 patients were enrolled from 13 institutions. One patient was ineligible, and the remaining 72 patients were preregistered. The tumours of 3 and 14 patients were intraoperatively diagnosed as benign lesions and adenocarcinomas with mixed subtype, respectively. Intraoperative cytological/histological examination of surgical margin was not performed in 2 patients, and the remaining 53 patients were ultimately eligible for this study. The mean tumour size was 14.0 mm and the mean GGO ratio was 95.9%. Thirty-nine and 14 patients underwent wedge resection and segmentectomy, respectively. Although all tumours were intraoperatively diagnosed as bronchioloalveolar carcinomas, 6 were ultimately diagnosed as adenocarcinoma with a mixed subtype. No completion lobectomy was performed. As of 1 May 2017, no recurrence of the original lung cancer was observed during 60.0-126.3 months after surgery. Two patients died from other diseases. The 5-year disease-specific and overall survival rates were 100% and 98.1%, respectively. The reduction in the pulmonary function after limited resection was minimal. CONCLUSIONS: With these criteria, limited resection was performed safely without any recurrence, and the postoperative pulmonary function was well preserved. The outcomes of limited resection for small-sized lung cancer with GGOs that met the criteria of this study were satisfactory.
OBJECTIVES: The incidence of small-sized pulmonary adenocarcinomas with ground-glass opacity (GGO) has recently increased, with excellent postoperative prognosis. The limited resection of such cancers has been deemed to be acceptable based on retrospective studies. We conducted a prospective multi-institutional study evaluating the validity of limited resection for small-sized pulmonary adenocarcinoma with GGO. METHODS: The inclusion criteria were 25-80 years of age, no prior treatment, a maximum tumour diameter of 8-20 mm, a GGO ratio of ≥ 80%, clinical T1N0M0, lower 18F-fluorodeoxyglucose accumulation than the mediastinum, resectable by sublobar resection, pulmonary lobectomy tolerable and an intraoperative pathological diagnosis of bronchiloalveolar carcinoma. Wedge resection was preferred, but segmentectomy was permitted. Disease-specific survival and overall survival were analysed. RESULTS: From November 2006 to April 2012, 73 patients were enrolled from 13 institutions. One patient was ineligible, and the remaining 72 patients were preregistered. The tumours of 3 and 14 patients were intraoperatively diagnosed as benign lesions and adenocarcinomas with mixed subtype, respectively. Intraoperative cytological/histological examination of surgical margin was not performed in 2 patients, and the remaining 53 patients were ultimately eligible for this study. The mean tumour size was 14.0 mm and the mean GGO ratio was 95.9%. Thirty-nine and 14 patients underwent wedge resection and segmentectomy, respectively. Although all tumours were intraoperatively diagnosed as bronchioloalveolar carcinomas, 6 were ultimately diagnosed as adenocarcinoma with a mixed subtype. No completion lobectomy was performed. As of 1 May 2017, no recurrence of the original lung cancer was observed during 60.0-126.3 months after surgery. Two patients died from other diseases. The 5-year disease-specific and overall survival rates were 100% and 98.1%, respectively. The reduction in the pulmonary function after limited resection was minimal. CONCLUSIONS: With these criteria, limited resection was performed safely without any recurrence, and the postoperative pulmonary function was well preserved. The outcomes of limited resection for small-sized lung cancer with GGOs that met the criteria of this study were satisfactory.
Authors: Gregory T Kennedy; Feredun S Azari; Elizabeth Bernstein; Charuhas Desphande; Azra Din; Isvita Marfatia; John C Kucharczuk; Edward J Delikatny; Philip S Low; Sunil Singhal Journal: Ann Thorac Surg Date: 2021-11-10 Impact factor: 5.102