Curative wedge resection for non-invasive bronchioloalveolar carcinoma

Pure bronchioloalveolar carcinomas have no stromal, vascular or pleural invasion, and they are candidates for curative wedge resection, although standard operative procedure for lung cancer is a pulmonary lobectomy. Most lung cancers with ground glass opacity (GGO), namely faint homogeneous shadows with sharp margin, are pure bronchioloalveolar carcinomas. This report presents the results of a pilot study on wedge resection with candidate selection by high-resolution computed tomography and positron emission tomography with 18F-fluorodeoxyglucose (FDG). The criteria for wedge resection were; 1) clinically no nodal or distant metastasis, 2) the location of the tumor was peripheral enough to undergo wedge resection, 3) the diameter of the shadow was 8-20 mm, 4) GGO% (diameter of GGO area/diameter of whole tumor) was 80% or over, 5) FDG uptake of the tumor was less than that of the mediastinum, 6) the intraoperative pathological diagnosis was non-invasive bronchioloalveolar carcinoma, and 7) informed consent was obtained. Nine tumors from 8 patients were selected in the study. The maximum diameter of the tumors was 9-18 mm and GGO% was 82-100%. All of nine tumors were treated with a wedge resection under video-assisted thoracic surgery. The postoperative courses were uneventful and no recurrence has been detected after 19-50-month follow-up. The changes in pulmonary function before and after the surgery were minimal. In conclusion, wedge resections were safely performed without any recurrence, and the postoperative pulmonary function was well preserved, suggesting the advantage of wedge resections for non-invasive bronchioloalveolar carcinomas.