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Ann Thorac Surg 1995;60:615-623
© 1995 The Society of Thoracic Surgeons
Accepted for publication April 1, 1995.
* Address reprint requests to Dr Ginsberg, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021.
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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T. Koike, K.-i. Togashi, T. Shirato, S. Sato, H. Hirahara, M. Sugawara, F. Oguma, H. Usuda, and I. Emura Limited Resection for Noninvasive Bronchioloalveolar Carcinoma Diagnosed by Intraoperative Pathologic Examination Ann. Thorac. Surg., October 1, 2009; 88(4): 1106 - 1111. [Abstract] [Full Text] [PDF] |
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M. Okada Invited Commentary Ann. Thorac. Surg., October 1, 2009; 88(4): 1111 - 1111. [Full Text] [PDF] |
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S. Yamada, A. Suga, Y. Inoue, and H. Inoue Use of multi-detector row angiography for the arrangement of video-assisted modified segmental resection Eur J Cardiothorac Surg, October 1, 2009; 36(4): 727 - 730. [Abstract] [Full Text] [PDF] |
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H. Igai, M. Takahashi, K. Ohata, A. Yamashina, T. Matsuoka, K. Kameyama, T. Nakagawa, and N. Okumura Surgical treatment for non-small cell lung cancer in octogenarians - the usefulness of video-assisted thoracic surgery Interact CardioVasc Thorac Surg, August 1, 2009; 9(2): 274 - 277. [Abstract] [Full Text] [PDF] |
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H. Oizumi, N. Kanauchi, H. Kato, M. Endoh, S.-i. Takeda, J. Suzuki, K. Fukaya, and M. Sadahiro Total thoracoscopic pulmonary segmentectomy Eur J Cardiothorac Surg, August 1, 2009; 36(2): 374 - 377. [Abstract] [Full Text] [PDF] |
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A. Brunelli, A. Charloux, C. T. Bolliger, G. Rocco, J-P. Sculier, G. Varela, M. Licker, M. K. Ferguson, C. Faivre-Finn, R. M. Huber, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) Eur. Respir. J., July 1, 2009; 34(1): 17 - 41. [Abstract] [Full Text] [PDF] |
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R. Maeda, N. Isowa, H. Onuma, H. Miura, T. Harada, H. Touge, H. Tokuyasu, and Y. Kawasaki The maximum standardized uptake values on positron emission tomography to predict the Noguchi classification and invasiveness in clinical stage IA adenocarcinoma measuring 2 cm or less in size Interact CardioVasc Thorac Surg, July 1, 2009; 9(1): 70 - 73. [Abstract] [Full Text] [PDF] |
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R. Maeda, N. Isowa, H. Onuma, H. Miura, T. Harada, H. Touge, H. Tokuyasu, and Y. Kawasaki The maximum standardized 18F-fluorodeoxyglucose uptake on positron emission tomography predicts lymph node metastasis and invasiveness in clinical stage IA non-small cell lung cancer Interact CardioVasc Thorac Surg, July 1, 2009; 9(1): 79 - 82. [Abstract] [Full Text] [PDF] |
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A. Kilic, M. J. Schuchert, B. L. Pettiford, A. Pennathur, J. R. Landreneau, J. P. Landreneau, J. D. Luketich, and R. J. Landreneau Anatomic Segmentectomy for Stage I Non-Small Cell Lung Cancer in the Elderly Ann. Thorac. Surg., June 1, 2009; 87(6): 1662 - 1668. [Abstract] [Full Text] [PDF] |
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M. Shapiro, T. S. Weiser, J. P. Wisnivesky, C. Chin, M. Arustamyan, and S. J. Swanson Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1388 - 1393. [Abstract] [Full Text] [PDF] |
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P. M. B. van Tilburg, H. Stam, H. C. Hoogsteden, and R. J. van Klaveren Pre-operative pulmonary evaluation of lung cancer patients: a review of the literature Eur. Respir. J., May 1, 2009; 33(5): 1206 - 1215. [Abstract] [Full Text] [PDF] |
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K. Kameyama, M. Takahashi, K. Ohata, H. Igai, A. Yamashina, T. Matsuoka, T. Nakagawa, and N. Okumura Evaluation of the new TNM staging system proposed by the International Association for the Study of Lung Cancer at a single institution. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1180 - 1184. [Abstract] [Full Text] [PDF] |
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K. Yoshimoto, H. Nomori, T. Mori, H. Kobayashi, Y. Ohba, H. Shibata, K. Tashiro, S. Shiraishi, and T. Kobayashi Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1200 - 1205. [Abstract] [Full Text] [PDF] |
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A. Watanabe, S. Ohori, S. Nakashima, T. Mawatari, N. Inoue, Y. Kurimoto, and T. Higami Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas Eur J Cardiothorac Surg, May 1, 2009; 35(5): 775 - 780. [Abstract] [Full Text] [PDF] |
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A. Pennathur, J. D. Luketich, D. E. Heron, G. Abbas, S. Burton, M. Chen, W. E. Gooding, C. Ozhasoglu, R. J. Landreneau, and N. A. Christie Stereotactic radiosurgery for the treatment of stage I non-small cell lung cancer in high-risk patients. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 597 - 604. [Abstract] [Full Text] [PDF] |
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T. Chamogeorgakis, C. Ieromonachos, E. Georgiannakis, and D. Mallios Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients? Interact CardioVasc Thorac Surg, March 1, 2009; 8(3): 364 - 372. [Abstract] [Full Text] [PDF] |
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R. Rami-Porta and M. Tsuboi Sublobar resection for lung cancer Eur. Respir. J., February 1, 2009; 33(2): 426 - 435. [Abstract] [Full Text] [PDF] |
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E. Jakobsen, T. Palshof, K. Osterlind, and H. Pilegaard Data from a national lung cancer registry contributes to improve outcome and quality of surgery: Danish results Eur J Cardiothorac Surg, February 1, 2009; 35(2): 348 - 352. [Abstract] [Full Text] [PDF] |
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