[Current Status of Limited Resection for Lung Cancer as Minimally Invasive Surgery]

This review article describes limited resection for lung cancer based on previous reports and a retrospective examination of the operative results at our hospital.The importance of limited resection as a surgical treatment is becoming much greater than before. In minimally invasive surgery for lung cancer, ① limited resection for pulmonary functional preservation, ② limited resection of lymph node dissection, and ③ minimally invasive thoracic approach may be considered. Radical segmentectomy was limited to the cases registered in the clinical trials [the Japan Clinical Oncology Group (JCOG) study 0802/1211]to verify the validity of limited surgery. The patients who would not tolerate lobectomy underwent passive sublobar resection. Selective lymph node dissection(SLND) is commonly performed in daily clinical practice in Japan, although there is no scientific verification proven by prospective study clinical trials. Since 2013, the indication for selective lymph node dissection in our hospital has been a clinico-surgical N0 cases with a tumor diameter of 5 cm or less, excluding the right middle lobe, left lingular segment, and S6 primary tumor. Rapid intraoperative diagnosis of lymph node metastases is indispensable. Limited resection involves less surgical invasion in terms of operative duration and blood loss volume than a standard procedure, with fewer postoperative complications. In the future, the results of randomized controlled trials (RCTs) originated in Japan is expected to determine whether segmentectomy and SLND are valid and practical enough to become standard procedures of surgical treatment for early-staged patients. In limited resection for lung cancer, it is important to evaluate lymph node, not only preoperatively but also intraoperatively making appropriate diagnoses.