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Ann Thorac Surg 1995;60:615-622
© 1995 The Society of Thoracic Surgeons


Original Articles: General Toracic

Randomized Trial of Lobectomy Versus Limited Resection for T1 N0 Non-Small Cell Lung Cancer

Accepted for publication April 1, 1995.

Abstract

Background. It has been reported that limited resection (segment or wedge) is equivalent to lobectomy in the management of early stage (T1-2 N0) non-small cell lung cancer.

Methods. A prospective, multiinstitutional randomized trial was instituted comparing limited resection with lobectomy for patients with peripheral T1 N0 non-small cell lung cancer documented at operation. Analysis included locoregional and distant recurrence rates, 5-year survival rates, perioperative morbidity and mortality, and late pulmonary function assessment.

Results. There were 276 patients randomized, with 247 patients eligible for analysis. There were no significant differences for all stratification variables, selected prognostic factors, perioperative morbidity, mortality, or late pulmonary function. In patients undergoing limited resection, there was an observed 75% increase in recurrence rates (p = 0.02, one-sided) attributable to an observed tripling of the local recurrence rate (p = 0.008 two-sided), an observed 30% increase in overall death rate (p = 0.08, one-sided), and an observed 50% increase in death with cancer rate (p = 0.09, one-sided) compared to patients undergoing lobectomy (p = 0.10, one-sided was the predefined threshold for statistical significance for this equivalency study).

Conclusions. Compared with lobectomy, limited pulmonary resection does not confer improved perioperative morbidity, mortality, or late postoperative pulmonary function. Because of the higher death rate and locoregional recurrence rate associated with limited resection, lobectomy still must be considered the surgical procedure of choice for patients with peripheral T1 N0 non-small cell lung cancer.




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Eur. J. Cardiothorac. Surg.Home page
W. Sienel, C. Stremmel, A. Kirschbaum, L. Hinterberger, E. Stoelben, J. Hasse, and B. Passlick
Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localisation and width of resection margins -- implications for patient selection for segmentectomy
Eur. J. Cardiothorac. Surg., March 1, 2007; 31(3): 522 - 528.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
M. Okada, T. Mimura, J. Ikegaki, H. Katoh, H. Itoh, and N. Tsubota
A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting
J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 753 - 758.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
H. Nomori, K. Ikeda, T. Mori, H. Kobayashi, K. Iwatani, K. Kawanaka, S. Shiraishi, and T. Kobayashi
Sentinel node navigation segmentectomy for clinical stage IA non-small cell lung cancer
J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 780 - 785.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
P. A. Linden, B. Y. Yeap, M. Y. Chang, W. G. Henderson, M. T. Jaklitsch, S. Khuri, D. J. Sugarbaker, and R. Bueno
Morbidity of Lung Resection After Prior Lobectomy: Results from the Veterans Affairs National Surgical Quality Improvement Program
Ann. Thorac. Surg., February 1, 2007; 83(2): 425 - 432.
[Abstract] [Full Text] [PDF]


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ChestHome page
J. B. Zwischenberger
Wedge Resection: When a Little Is Not Enough
Chest, January 1, 2007; 131(1): 6 - 7.
[Full Text] [PDF]


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ChestHome page
A. Kraev, D. Rassias, J. Vetto, M. Torosoff, P. Ravichandran, C. Clement, A. Kadri, and R. Ilves
Wedge Resection vs Lobectomy: 10-Year Survival in Stage I Primary Lung Cancer
Chest, January 1, 2007; 131(1): 136 - 140.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
P. C. Lee, R. J. Korst, J. L. Port, Y. Kerem, A. L. Kansler, and N. K. Altorki
Long-term survival and recurrence in patients with resected non-small cell lung cancer 1 cm or less in size
J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1382 - 1388.
[Abstract] [Full Text] [PDF]


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JCOHome page
R. Timmerman, R. McGarry, C. Yiannoutsos, L. Papiez, K. Tudor, J. DeLuca, M. Ewing, R. Abdulrahman, C. DesRosiers, M. Williams, et al.
Excessive Toxicity When Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Lung Cancer
J. Clin. Oncol., October 20, 2006; 24(30): 4833 - 4839.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
M. Okada, T. Koike, M. Higashiyama, Y. Yamato, K. Kodama, and N. Tsubota
Radical sublobar resection for small-sized non small cell lung cancer: A multicenter study
J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 769 - 775.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
A. Ketchedjian, B. D.T. Daly, H. C. Fernando, L. Florin, C. J. Hunter, D. M. Morelli, and R. J. Shemin
Location as an important predictor of lymph node involvement for pulmonary adenocarcinoma.
J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 544 - 548.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
T. Shiraishi, T. Shirakusa, M. Hiratsuka, S. Yamamoto, and A. Iwasaki
Video-assisted thoracoscopic surgery lobectomy for c-T1N0M0 primary lung cancer: its impact on locoregional control.
Ann. Thorac. Surg., September 1, 2006; 82(3): 1021 - 1026.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
A. El-Sherif, W. E. Gooding, R. Santos, B. Pettiford, P. F. Ferson, H. C. Fernando, S. J. Urda, J. D. Luketich, and R. J. Landreneau
Outcomes of Sublobar Resection Versus Lobectomy for Stage I Non-Small Cell Lung Cancer: A 13-Year Analysis
Ann. Thorac. Surg., August 1, 2006; 82(2): 408 - 416.
[Abstract] [Full Text] [PDF]


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ThoraxHome page
T Treasure and M Utley
Survival after resection for primary lung cancer.
Thorax, August 1, 2006; 61(8): 649 - 650.
[Full Text] [PDF]


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ThoraxHome page
T-E Strand, H Rostad, B Moller, and J Norstein
Survival after resection for primary lung cancer: a population based study of 3211 resected patients
Thorax, August 1, 2006; 61(8): 710 - 715.
[Abstract] [Full Text] [PDF]


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ThoraxHome page
J-E C Holty and M K Gould
When in doubt should we cut it out? The role of surgery in non-small cell lung cancer.
Thorax, July 1, 2006; 61(7): 554 - 556.
[Full Text] [PDF]


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ThoraxHome page
G Wright, R L Manser, G Byrnes, D Hart, and D A Campbell
Surgery for non-small cell lung cancer: systematic review and meta-analysis of randomised controlled trials
Thorax, July 1, 2006; 61(7): 597 - 603.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
G. J. Kelloff, S. M. Lippman, A. J. Dannenberg, C. C. Sigman, H. L. Pearce, B. J. Reid, E. Szabo, V. C. Jordan, M. R. Spitz, G. B. Mills, et al.
Progress in Chemoprevention Drug Development: The Promise of Molecular Biomarkers for Prevention of Intraepithelial Neoplasia and Cancer--A Plan to Move Forward
Clin. Cancer Res., June 15, 2006; 12(12): 3661 - 3697.
[Abstract] [Full Text] [PDF]


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Eur Respir JHome page
C. T. Bolliger, T. G. Sutedja, J. Strausz, and L. Freitag
Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents.
Eur. Respir. J., June 1, 2006; 27(6): 1258 - 1271.
[Abstract] [Full Text] [PDF]


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Asian Cardiovasc. Thorac. Ann.Home page
B. Mahesh, C. Forrester-Wood, K. Amer, and R. Ascione
Value of Wedge Resection for Lung Cancer in Poor Cardiopulmonary Status Patients
Asian Cardiovasc Thorac Ann, April 1, 2006; 14(2): 123 - 127.
[Abstract] [Full Text] [PDF]


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Am. J. Roentgenol.Home page
S. S. Shim, K. S. Lee, M. J. Chung, H. Kim, O J. Kwon, and S. Kim
Do hemodynamic studies of stage t1 lung cancer enable the prediction of hilar or mediastinal nodal metastasis?
Am. J. Roentgenol., April 1, 2006; 186(4): 981 - 988.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
T. J. Birdas, R. P.M. Koehler, A. Colonias, M. Trombetta, R. H. Maley Jr, R. J. Landreneau, and R. J. Keenan
Sublobar Resection With Brachytherapy Versus Lobectomy for Stage Ib Nonsmall Cell Lung Cancer
Ann. Thorac. Surg., February 1, 2006; 81(2): 434 - 439.
[Abstract] [Full Text] [PDF]


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Jpn J Clin OncolHome page
T. Kawaguchi, A. Matsumura, K. Iuchi, S. Ishikawa, H. Maeda, S. Fukai, H. Komatsu, and M. Kawahara
Second Primary Cancers in Patients with Stage III Non-Small Cell Lung Cancer Successfully Treated with Chemo-radiotherapy
Jpn. J. Clin. Oncol., January 1, 2006; 36(1): 7 - 11.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
M. M. Oken, P. M. Marcus, P. Hu, T. M. Beck, W. Hocking, P. A. Kvale, J. Cordes, T. L. Riley, S. D. Winslow, S. Peace, et al.
Baseline Chest Radiograph for Lung Cancer Detection in the Randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial
J Natl Cancer Inst, December 21, 2005; 97(24): 1832 - 1839.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
H. Matsuoka, M. Okada, T. Sakamoto, and N. Tsubota
Reply to Shanmugan et al.
Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 913 - 913.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
H. Harada, M. Okada, T. Sakamoto, H. Matsuoka, and N. Tsubota
Functional Advantage After Radical Segmentectomy Versus Lobectomy for Lung Cancer
Ann. Thorac. Surg., December 1, 2005; 80(6): 2041 - 2045.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
G. Shanmugam, A. Jilaihawi, and D. Prakash
Pulmonary resections in young octogenarians.
Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 912 - 913.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
C.S. Pramesh, R. C. Mistry, and J. Agarwal
How Should Bronchioloalveolar Carcinoma of the Lung 3 Centimeters or Less Be Treated?
Ann. Thorac. Surg., November 1, 2005; 80(5): 1978 - 1978.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
H. Sakurai, Y. Dobashi, and M. Matsumoto
Reply
Ann. Thorac. Surg., November 1, 2005; 80(5): 1979 - 1979.
[Full Text] [PDF]


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ChestHome page
F. Barlesi, L. Boyer, C. Doddoli, S. Antoniotti, P. Thomas, and P. Auquier
The Place of Patient Satisfaction in Quality Assessment of Lung Cancer Thoracic Surgery
Chest, November 1, 2005; 128(5): 3475 - 3481.
[Abstract] [Full Text] [PDF]


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ChestHome page
C. L. Nguyen, W. J. Scott, N. A. Young, T. Rader, L. R. Giles, and M. Goldberg
Radiofrequency Ablation of Primary Lung Cancer: Results From an Ablate and Resect Pilot Study
Chest, November 1, 2005; 128(5): 3507 - 3511.
[Abstract] [Full Text] [PDF]


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RadioGraphicsHome page
C. J. Simon, D. E. Dupuy, and W. W. Mayo-Smith
Microwave Ablation: Principles and Applications
RadioGraphics, October 1, 2005; 25(suppl_1): S69 - S83.
[Abstract] [Full Text] [PDF]


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ChestHome page
S. Sawada, E. Komori, N. Nogami, A. Bessho, Y. Segawa, T. Shinkai, M. Nakata, and M. Yamashita
Advanced Age Is Not Correlated With Either Short-term or Long-term Postoperative Results in Lung Cancer Patients In Good Clinical Condition
Chest, September 1, 2005; 128(3): 1557 - 1563.
[Abstract] [Full Text] [PDF]


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Am. J. Respir. Crit. Care Med.Home page
S. G. Spiro and G. A. Silvestri
One Hundred Years of Lung Cancer
Am. J. Respir. Crit. Care Med., September 1, 2005; 172(5): 523 - 529.
[Abstract] [Full Text] [PDF]


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ChestHome page
C. M. Mery, A. N. Pappas, R. Bueno, Y. L. Colson, P. Linden, D. J. Sugarbaker, and M. T. Jaklitsch
Similar Long-term Survival of Elderly Patients With Non-small Cell Lung Cancer Treated With Lobectomy or Wedge Resection Within the Surveillance, Epidemiology, and End Results Database
Chest, July 1, 2005; 128(1): 237 - 245.
[Abstract] [Full Text] [PDF]




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