Author of

• 15301

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  P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Treatment of Localized Disease - NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 15330

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    P3.02-029 - Micro- Small Lung Cancer (≤1cm) Needs Lobectomy with Systematic Lymph Node Dissection or Sublobular Limited Resection Only? (ID 1671)

    09:30 - 09:30  |  Author(s): N. Chen
    • Abstract

    Background:
    Lung cancer is increasing rapidly in China. More and more pulmonary ground-glass opacity (GGO) were detected, most are not malignant, but some are indeed early stage lung cancer, micro- small lung cancer (≤1cm) (mi-SLC), either adenocarcinoma in situ (AIS), or minimally invasive adenocarcinoma (MIA). Surgical resection could cure most of them, but the resection extent for mi-SLC is a dilemma. Typical cases will be discussed.
    
    Methods:
    Case 1: Woman, aged 67 in Mar 2013, left upper lobe GGO 0.8cm, not peripheral; hypertension and coronary heart disease 10 years; anti-inflammatory strategy used, GGO size increased a little one month later. Her mental stress increased greatly. Case 2: Woman, aged 59 in Nov 2013, right middle lobe pure GGO 1.0cm, peripheral; sickly status for years; anti-inflammatory strategy used, GGO size no change. Both patients were referral to China Medical University Lung Cancer Center for surgical resection, “miMRST”, minimally invasive small incision, muscle- and rib-sparing thoracotomy, minimally invasive lung cancer radical surgery, was scheduled.
    
    Results:
    About 10cm lateral chest incision was enough for most lung cancer resection and mediastinal lymph node dissection, with the latissimus dorsi and serratus anterior muscles were protected, no rib cut needed. For Case 1, the lesion could not be located, left upper lobe resection was undergone as expected; frozen pathological diagnosis was AIS; swollen lymph node 3a,5,6,10,11,12 and surrounding adipose tissue were systematicly dissected. No lymph node in subcarinal and pulmonary ligament region was found. Postoperative pathology confirmed AIS, no lymph node metastasis. For Case 2, wedge resection was performed as expected; cutting edges of the lung were more than 2cm away from the tumor. The frozen pathological diagnosis was atypical adenomatous hyperplasia (AAH), cancer to be excluded by wax slide pathology. No swollen lymph node was found and no dissection done. Postoperative pathology was minimally invasive adenocarcinoma (MIA). The patients recovered much better and quickly than other patients who underwent traditional “large-incision” posterolateral thoracotomy. Regular follow-up: both patients are alive healthily, in her 3rd year postoperatively for Case 1, in her 2nd year postoperatively for Case 2; no sign of recurrence and metastasis. No adjuvant treatment used.
    
    Conclusion:
    For these micro- small lung cancer (≤1cm), wedge resection is the first choice for frozn pathological diagnosis; if the diagnosis is AAH, wedge resection should be enough; if is AIS, lobular resection, at least segment resection is to be performed; if the diagnosis is MIA or just lung cancer, thus standard lobectomy plus systematic lymph node dissection is essential. For AIS, lymph node dissection is a dilemma. For GGO not in peripheral part, if segment resection is difficult, loectomy become dilemma. But for wedge resection of AAH, it would become a bigger dilemma when the postoperative pathology become MIA. Prospective observation of more patients with long follow-up will be more helpful. (This study was partly supported by the Fund for Scientific Research of The First Hospital of China Medical University, No.FSFH1210).