Feasibility of segmental resection in non-small-cell lung cancer with ground-glass opacity

• Published in: European journal of cardio-thoracic surgery 2014-09, Vol.46 (3), p.375-379
• Main Authors: Iwata, Hisashi, Shirahashi, Koyo, Mizuno, Yoshimasa, Yamamoto, Hirotaka, Takemura, Hirofumi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Animals; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Feasibility Studies; Female; Humans; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Pneumonectomy - methods; Retrospective Studies; Survival Analysis
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezu021

OBJECTIVES Recently, lung segmental resection has been increasingly performed in patients with lung cancer. In this study, the results of radical segmentectomy (RS) and palliative segmentectomy (PS) were compared retrospectively. METHODS Segmentectomy was performed to remove a primary lung cancer in 87 cases. RS was performed for pure ground-glass opacity (GGO), >50% GGO and diameter less than 2 cm and less than 10 mm solid tumours. PS was performed in patients with poor lung function or relapse, or at high risk for surgery. A total of 84 cases, excluding 3 cases of relapse, were investigated. RESULTS The pathological stage of RS was IA in 32 (94.1%) and IB in 2 (5.9%). The pathological stage of PS was IA in 23 (46.0%), IB in 15 (30.0%), IIA in 5 (10.0%), IIB in 1 (2.0%), IIIA in 4 (8.0%) and IV in 2 (4.0%). The preoperative characteristics of RS were compared with those of PS for pathological stage I. The mean age was significantly lower for RS cases (67.4 ± 9.9 years) than for PS cases (73.0 ± 9.0 years; P = 0.013). Tumour size was significantly smaller in RS cases (14.7 ± 4.6 mm) than in PS cases (22.0 ± 8.9 mm; P < 0.001). The tumour standardized uptake value of 18F-fluorodeoxyglucose positron emission tomography was significantly lower in RS cases (1.2 ± 1.6) than in PS cases (6.0 ± 6.1; P < 0.001). Serum carcinoembryonic antigen level was lower in RS cases (2.8 ± 1.8 ng/ml) than in PS cases (4.9 ± 5.0; P = 0.019). The mean duration of drainage was shorter in RS (2.5 ± 0.7 days) than in PS (3.9 ± 2.6 days; P = 0.004). Postoperative complications occurred in 6 RS cases (17.6%) and 12 PS cases (29.3%). Overall 5-year survival was higher in RS (100%) than in PS (66.2%; P = 0.003). Five-year disease-free survival was higher in RS (100%) than in PS (66.2%; P = 0.002). Recurrence was detected in 6 PS patients; 10 PS cases showed tumour with GGO and survived without recurrence. CONCLUSIONS Our RS is feasible for stage I lung cancer with specific computed tomography features, such as small size, GGO or peripheral location.