Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11607

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    P2.07-012 - Long-term results of limited resection for small adenocarcinoma showing ground-glass opacity (ID 1269)

    09:30 - 09:30  |  Author(s): T. Hirono
    • Abstract

    Background
    In 2005, we reported the study of intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. At that time, only 14 patients with a small adenocarcinoma showing ground-glass opacity (GGO) had undergone limited resection. After that, we have continued limited resection and follow-up. The median follow-up time from the operation has reached 80 months, so we analyze the long-term results of this procedure.

    Methods
    Between 1996 and 2013, we enrolled 56 patients in this study. Entry criteria were: 1) cT1aN0M0 peripheral adenocarcinoma, 2) High resolution computed tomography (HRCT) findings suspected of having a Noguchi type A or B adenocarcinoma, and 3) pulmonary function adequate to permit lobectomy. When the tumor consisted of GGO only or GGO with a solid component that accounted for less than 50% of the surface area on HRCT, the tumor was suspected to be Noguchi type A or B adenocarcinoma. Wedge resection or segmentectomy was performed, and was followed by an intraoperative pathologic exploration. After confirming the diagnosis of Noguchi type A or B by intraoperative pathologic exploration, operation was completed. No systematic lymph node dissection or sampling was performed. If the lesion was not Noguchi type A or B, extended segmentectomy or lobectomy with systematic lymph node dissection was performed instead.

    Results
    Between 1996 and 2013, we enrolled 56 patients in this study. Limited resection was performed in all patients, wedge resection in 52, and segmentectomy in 4. Intraoperative pathologic exploration revealed that the lesion was not Noguchi type A or B in 11 patients. In these 11patients, we underwent extended segmentectomy in 2 and lobectomy in 9 with systematic lymph node dissection. Intentional limited resection was completed in 45 patients. Of these, 7 had Noguchi type A tumors, and 38 had Noguchi Type B tumors based on intraoperative pathologic exploration. Postoperative pathologic examination revealed 10 patients with Noguchi type A, 31 patients with Noguchi type B, and 4 patients with Noguchi type C. We recommended reoperation to 4 patients with Noguchi type C, but all refused reoperation and has been carefully followed at 3-month intervals. There was no postoperative and 30-day mortality or in-hospital mortality. There were no morbidities. All patients but one are alive without recurrence of lung cancer at the time of writing. Only one patient died of malignant lymphoma without recurrence. The follow-up periods have ranged from 6 to 195 months, and median follow-up period is 80 months. The overall 5- and 10-year survival rates were 96% and 96%, respectively. The 5- and 10-year recurrence –free proportions were 100% and 100%, respectively.

    Conclusion
    When patients are carefully selected by preoperative HRCT and intraoperative pathologic exploration, limited resection can be an acceptable option for the treatment of T1aN0M0 adenocarcinoma showing GGO lesion.