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Published on: February 12, 2017
Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer
Teruaki Koike1, Yasushi Yamato, Katsuo Yoshiya
1Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan. koike@niigata-cc.niigata.niigata.jp
Objective:
The present study was undertaken to demonstrate that limited pulmonary resection for peripheral small-sized lung cancer yields outcomes not inferior to those of lobectomy.
Methods:
During the 9-year period from 1992 to 2000, patients with cT1 N0 M0 peripheral non-small cell lung cancer whose maximum tumor diameter was 2 cm or less on diagnostic imaging and in whom lobectomy was determined to be feasible were treated with limited resection if the patient consented to the procedure and with lobectomy if consent to limited resection was not obtained. The survival and clinical outcome of the patients whose tumors were postoperatively staged as pT1 N0 M0 were compared between the limited resection group (n = 74) and the lobectomy group (n = 159).
Results:
The limited resection group consisted of 60 patients treated with segmentectomy and 14 patients treated with wedge resection. Among patients followed up for a mean period of 52 months after the operation, neither the 3-year nor 5-year survivals differed significantly between the limited resection group (3-year survival, 94.0%; 5-year survival, 89.1%) and the lobectomy group (3-year survival, 97.0%; 5-year survival, 90.1%). Postoperative tumor recurrence was noted in 5 patients after limited resection and in 9 patients after lobectomy, and the difference in the incidence of postoperative recurrence between the 2 groups was not significant.
Conclusions:
The results of this study indicate that in patients with peripheral T1 N0 M0 non-small cell lung cancer whose maximum tumor diameter was 2 cm or less, the outcome of limited pulmonary resection is comparable with that of pulmonary lobectomy.
Insights
Limited pulmonary resection for small lung cancers offers survival and recurrence rates comparable to lobectomy. This approach provides similar outcomes for patients with peripheral non-small cell lung cancer.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Early-stage non-small cell lung cancer (NSCLC) treatment often involves surgical resection.
- Lobectomy is the standard surgical procedure, but concerns exist regarding morbidity for some patients.
- Limited resection techniques are being explored as alternatives for specific patient groups.
Purpose of the Study:
- To compare the oncological outcomes of limited pulmonary resection versus lobectomy for peripheral, small-sized NSCLC.
- To determine if limited resection is non-inferior to lobectomy in terms of survival and recurrence rates.
- To evaluate the safety and efficacy of limited resection in a selected patient cohort.
Main Methods:
- A retrospective study comparing patients with clinical T1N0M0 peripheral NSCLC (≤2 cm tumor diameter) from 1992-2000.
- Patients underwent either limited resection (segmentectomy or wedge resection) or lobectomy based on consent.
- Survival and recurrence rates were compared between the 74 patients in the limited resection group and 159 in the lobectomy group.
Main Results:
- No significant difference in 3-year (94.0% vs 97.0%) or 5-year (89.1% vs 90.1%) survival rates between limited resection and lobectomy groups.
- Postoperative tumor recurrence rates were also not significantly different (5 patients vs 9 patients).
- Mean follow-up was 52 months, supporting the long-term comparability of both surgical approaches.
Conclusions:
- Limited pulmonary resection is a viable and comparable alternative to lobectomy for peripheral T1N0M0 NSCLC patients with small tumors (≤2 cm).
- This finding supports the consideration of limited resection in appropriate candidates, potentially reducing surgical morbidity.
- Outcomes suggest that oncological control can be achieved with less extensive surgery in select cases.
