Sublobar resection for lung adenocarcinoma meeting node-negative criteria on preoperative imaging.

Abstract

BACKGROUND:

This study evaluated the usefulness of sublobar resection for patients with clinical stage IA lung adenocarcinoma that met our proposed node-negative criteria: solid tumor size of less than 0.8 cm on high-resolution computed tomography or maximum standardized uptake value of less than 1.5 on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography.

METHODS:

A multicenter database of 618 patients with completely resected clinical stage IA lung adenocarcinoma who underwent preoperative high-resolution computed tomography and [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography was used to evaluate the surgical results of sublobar resection for patients who met our node-negative criteria.

RESULTS:

No patient who met the node-negative criteria had any pathological lymph node metastasis. Recurrence-free survival (RFS) and overall survival (OS) rates at 5 years were significantly higher for patients who met the node-negative criteria (RFS: 96.6%; OS: 95.9%) than for patients who did not (RFS: 75.5%, p<0.0001; OS: 83.1%, p<0.0001). Among patients who met the node-negative criteria, RFS and OS rates at 5 years were not significantly different between those who underwent lobectomy (RFS: 96.0%; OS: 95.9%) and those who underwent sublobar resection (RFS: 97.2%, p=0.94; OS: 95.9%, p=0.98). Of 264 patients with T1b (2-cm to 3-cm) tumors, 106 (40.2%) met the node-negative criteria.

CONCLUSIONS:

Sublobar resection without systematic nodal dissection is feasible for clinical stage IA lung adenocarcinoma that meets the above-mentioned node-negative criteria. Even a T1b tumor, which is generally unsuitable for intentional sublobar resection, can be a candidate for sublobar resection if it meets these node-negative criteria.

• Authors: Yasuhiro Tsutani, Yoshihiro Miyata, Haruhiko Nakayama, Sakae Okumura, Shuji Adachi, Masahiro Yoshimura, Morihito Okada
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 97 Issue 5 Pg. 1701-7 (May 2014) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 24679941 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Fluorodeoxyglucose F18

Topics

• Adenocarcinoma (diagnosis, mortality, surgery)
• Adult
• Aged
• Aged, 80 and over
• Cohort Studies
• Databases, Factual
• Disease-Free Survival
• Female
• Fluorodeoxyglucose F18
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Lung Neoplasms (diagnosis, mortality, surgery)
• Lymph Nodes (pathology)
• Male
• Middle Aged
• Multimodal Imaging
• Multivariate Analysis
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Pneumonectomy (methods, mortality)
• Positron-Emission Tomography (methods)
• Preoperative Care (methods)
• Proportional Hazards Models
• Retrospective Studies
• Survival Analysis
• Tomography, X-Ray Computed (methods)
• Treatment Outcome
• Tumor Burden