Original article: general thoracic
Is segmentectomy with lymph node assessment an alternative to lobectomy for non–small cell lung cancer of 2 cm or smaller?

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Abstract

Background. Lesser resection than the standard lobectomy for small-sized cT1N0M0 non–small cell lung cancers continues to be debated.

Methods. We reviewed specimens of 139 patients after lobectomy for cT1N0M0 cancer of 2 cm or less. In addition, we prospectively enrolled 70 patients able to tolerate a lobectomy, in a trial of lesser resection for these lesions. The limited procedure consisted of segmentectomy in which the resection line was delivered beyond the burdened segment, plus exploration of lymph nodes by frozen sectioning. This procedure was modified if the result was positive; this modified procedure was called extended segmentectomy.

Results. The nodal status after lobectomy was pN0, 107 patients; pN1, 12 patients; and pN2, 20 patients. Of the pN1 patients, 2 had only intralobar nodal involvement within the same segment of the main tumor. In the remaining 30 patients with nodal involvement, we ascertained the nodal involvement during the operation. Regarding intrapulmonary metastasis, 1 of 8 patients having this metastasis had the lesion at the segment where the main tumor was not located and had N2 disease, which was detected intraoperatively. If extended segmentectomy had been performed instead of lobectomy, the lesion could have been removed completely. The 5-year survival of patients with cT1N0M0 cancer of 2 cm or less was 87.3% after extended segmentectomy. There were no local recurrences and three noncancer-related deaths. Among patients with pT1N0M0 cancer of 2 cm or less, the 5-year survival was 87.1% in the extended segmentectomy group and 87.7% in the lobectomy group (p = 0.8008).

Conclusions. Extended segmentectomy should be considered as an alternative for patients with cT1N0M0 non–small cell lung cancer of 2 cm or smaller.

Section snippets

Patients and methods

Between June 1984 and December 1998, 1,453 patients underwent curative operation for primary non–small cell lung cancer. Curative operation was defined as the complete removal of the ipsilateral hilar and mediastinal lymph nodes together with the primary tumor including negative bronchial margins. Of the 1,453, 139 patients underwent lobectomy for cT1N0M0 tumor of 2 cm or less in diameter. After specimens were fixed and cut into slices 1 cm thick, they were investigated macroscopically and

Analysis of lobectomy for cT1N0M0 tumor of 2 cm or less in diameter

There were a total of 139 patients in this group (88 men and 51 women, mean age = 62.5 ± 9.2 years). The histopathologic diagnosis was adenocarcinoma in 103 patients, squamous cell carcinoma in 33, large cell carcinoma in 2, and carcinoid in 1. The pathologic nodal status was as follows: pN0 in 107 patients, pN1a in 2, pN1b in 10, and pN2 in 20. Two patients (1.4%) had N1a disease (involvement of only intralobar nodes), which was not detected during the procedure. All of the involved nodes were

Comment

In 1995, a prospective randomized trial of lobectomy versus limited resection for T1N0 non–small cell lung cancer less than 3 cm in diameter demonstrated that limited resection should not be considered because of its higher death rate and local recurrence [13]. We considered this study to have room for reconsideration. In the invited commentary at the end of that report, Drs Peters and Benfield respectively took a critical view of the conclusions [13]. It was noteworthy that this study included

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