Segmentectomy for selected cT1N0M0 non–small cell lung cancer: A prospective study at a single institute

Background To examine whether segmentectomy is radical for cT1N0M0 non–small cell lung cancer (NSCLC), a prospective single-arm study was performed at a single institution. Methods The criteria for segmentectomy were as follows: (1) peripheral-type cT1N0M0 NSCLC; (2) intraoperative frozen sections o...

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Published in:The Journal of thoracic and cardiovascular surgery 2012-07, Vol.144 (1), p.87-93
Main Authors: Nomori, Hiroaki, PhD, Mori, Takeshi, PhD, Ikeda, Koei, PhD, Yoshimoto, Kentaro, PhD, Iyama, Kenichi, PhD, Suzuki, Makoto, PhD
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Carcinoma, Non-Small-Cell Lung - pathology
Carcinoma, Non-Small-Cell Lung - surgery
Cardiology. Vascular system
Cardiothoracic Surgery
Chi-Square Distribution
Female
Humans
Lung Neoplasms - pathology
Lung Neoplasms - surgery
Male
Medical sciences
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Pneumology
Pneumonectomy - methods
Proportional Hazards Models
Prospective Studies
Respiratory Function Tests
Sentinel Lymph Node Biopsy
Survival Rate
Treatment Outcome
Tumors of the respiratory system and mediastinum
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Summary:Background To examine whether segmentectomy is radical for cT1N0M0 non–small cell lung cancer (NSCLC), a prospective single-arm study was performed at a single institution. Methods The criteria for segmentectomy were as follows: (1) peripheral-type cT1N0M0 NSCLC; (2) intraoperative frozen sections of sentinel nodes identified with isotope showing no metastasis; (3) surgical margins greater than 2 cm; (4) patient choice for segmentectomy; and (5) exclusion of right middle lobe tumors. From 2005 to 2009, of 245 patients with cT1N0M0 NSCLC, 195 (80%) were enrolled in the present study. Of these 195 patients, 179 ultimately underwent segmentectomy with systematic lymph node dissection. Of these 179 patients, 134 (75%) had tumors 2 cm or smaller, and 45 (25%) had tumors 2.1 cm to 3 cm. The median follow-up period was 43 months. Results All 181 tumors from 179 patients were stage pN0. Of the 179 patients, 6 developed distant site recurrence and 3 local recurrence (ie, 1 developed pulmonary metastases within the same lobe 21 months after segmentectomy and 2 developed local recurrence at the surgical margin 60 and 62 months after segmentectomy, respectively). The 5-year overall survival was 94% for patients with tumors 2 cm or smaller and 81% for those with 2.1-cm to 3-cm tumors. Postoperative pulmonary function was preserved at 90% ± 12% of preoperative levels. Conclusions Segmentectomy with systematic lymph node dissection with a sufficient surgical margin could be a radical treatment for selected cT1N0M0/pN0 NSCLC while preserving pulmonary function. The surgical margin should be monitored for the development of local recurrence for a long period after segmentectomy.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2012.03.034