Potential errors in staging primary pulmonary adenocarcinomas by sublobar resection.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Increasing interest exists in sublobar resection and staging lymphadenectomy (StLN) for stage I pulmonary adenocarcinoma.
• However, data on the impact of this approach on accurate staging is limited.

Purpose of the Study:

• To evaluate the potential impact of sublobar resections with StLN on the staging of pulmonary adenocarcinoma.
• To identify cases that may be understaged by this surgical approach.

Main Methods:

• A retrospective review of 241 consecutive wedge resections with subsequent completion lobectomy, bilobectomy, or trisegmentectomy and StLN.
• Comparison of tumor characteristics in wedge specimens with findings in the "second specimens" (completion resections) and lymph nodes.

Main Results:

• Residual tumor, additional nodules, or both were found in the lung parenchyma of 24 "second specimens".
• Accurate determination of overall tumor size and final pT was challenging in some cases due to orientation issues.
• Metastatic tumor was present exclusively in N1 lymph nodes in 10 cases, which would have been missed by StLN alone.

Conclusions:

• Sublobar resections with StLN could have understaged 19 (7.9%) of patients.
• This understaging involved misclassification of tumor size (pT) and lymph node involvement (pN).
• Preoperative imaging identified only a fraction of these potentially understaged cases, highlighting the limitations of current diagnostic methods.