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Complete resection in lung cancer surgery: proposed definition
Ramón Rami-Porta1, Christian Wittekind, Peter Goldstraw
1Complete Resection Subcommittee of the IASLC Staging Committee, Thoracic Surgery Service, Hospital Mutua de Terrassa, University of Barcelona, Plaza Dr. Robert, 5, 08221 Terrassa, Barcelona, Spain. rramip@teleline.es
An international definition for complete lung cancer resection is proposed, requiring microscopically free margins and specific nodal dissection. This aims to standardize surgical outcomes and improve prognostic studies for lung cancer patients.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Complete resection is crucial for lung cancer treatment outcomes.
- Existing definitions of complete resection lack international consensus.
- Standardization is needed for accurate prognostic evaluation.
Purpose of the Study:
- To establish an internationally accepted definition of complete resection in lung cancer surgery.
- To provide clear criteria for surgical success in lung cancer.
- To facilitate reproducible research on resection completeness.
Main Methods:
- The International Association for the Study of Lung Cancer (IASLC) Staging Committee formed a dedicated subcommittee.
- Review of previous definitions and TNM residual tumor classification rules.
- Consideration of literature and expert input from the IASLC Staging Committee.
Main Results:
- Complete resection necessitates microscopically free margins, systematic nodal dissection, no extracapsular nodal extension, and negative highest mediastinal nodes.
- Incomplete resection is defined by positive margins, nodal extension, unremoved positive nodes, or effusions.
- Uncertain resection applies when margins are free but other criteria are not met, or with bronchial margin involvement/positive cytology.
Conclusions:
- The proposed definitions for complete, incomplete, and uncertain resections offer clarity and reproducibility.
- These definitions are suitable for international prospective studies.
- Standardized definitions will aid in assessing the prognostic impact of surgical resection completeness.
