Junji Yoshida1, Genichiro Ishii1, Kanji Nagai1, Mitsuyo Nishimura1, Hiroyuki Ito2, Yoichi Kameda2, Haruhiko Nakayama2, Kouzou Yamada2, Yutaka Nishiwaki1.
1National Cancer Center Hospital East, Kashiwa, Japan, 2Kanagawa Cancer Center, Yokohama, Japan.
OBJECTIVE: Confirm limited resection efficacy as radical surgery in patients with HRCT indicated minimally invasive lung cancer. Confirm intraoperative cytology as a negative margin indicator and reliable margin non-recurrence predictor.
METHODS:
Enrollment requires patients with a tumor ≤2 cm in diameter, diagnosed or suspected as a clinical T1N0M0 carcinoma in the lung periphery. They have to have a HRCT scan indicating a sub-solid nodule with tumor disappearance ratio; TDR ≥0.5. (TDR = 1- DM/DL; DM: maximum tumor diameter on mediastinal settings, DL: maximum tumor diameter on lung settings). Patients with a malignancy history within the past 5 years or those unfit for lobectomy and systematic lymph node dissection are excluded.
We perform a wedge or segmental resection. The used stapling cartridges are washed with 50 ml saline. Washing saline is centrifuged and sediment stained using Papanicolaou’s method and examined for cancer cells. If cytology is cancer positive, additional margin is resected, and cytologic examination repeated. If the second exam is positive, a routine lobectomy and systematic lymph node dissection will be performed. Patients are followed up every 6 months by chest CT for the first 3 years, and annually thereafter for at least 5 years. The endpoint is 5 year local recurrence free survival rate.
RESULTS: This prospective study started in November 2003, and 51 patients have been enrolled as of September 2007. This was 4.1% of all resected lung cancer patients during this period. There were 18 men and 33 women, aged 30-75, with an average 62 years. Tumor sizes ranged from 7 to 20 mm on HRCT, averaging 15 mm. There were 8 Noguchi type A tumors, 25 type B tumors, 13 type C tumors, 3 inflammatory fibroses, one AAH and one malignant lymphoma. All cancers showed no vessel invasion or positive cytology results. No mortality or recurrence has occurred, but one patient developed postoperative pneumothorax.
CONCLUSIONS: The interim results appear encouraging. With about four years on this study, and considering the slow-growing nature of GGO lesions, it is still too early for strong conclusions, but our HRCT-based case selection appears valid and limited resection efficacious.
Back to 2008 Annual Meeting
Back to Program Outline