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Eur J Cardiothorac Surg 2003;24:159-164
© 2003 Elsevier Science NL

Review

Bronchioloalveolar carcinoma: myths and realities in the surgical management

^a Department of Thoracic Oncology, Faculty of Medicine, Univ. Méditerranée (Aix-Marseille II), Marseille Cedex, France
^b Department of Thoracic Surgery, Faculty of Medicine, Univ. Méditerranée (Aix-Marseille II), Marseille Cedex, France
^c Department of Pathology, Faculty of Medicine, Univ. Méditerranée (Aix-Marseille II), Marseille Cedex, France
^d Sainte-Marguerite Hospital, Assistance Publique – Hôpitaux de Marseille, and UPRES EA 22013, IFR Jean Roche, Marseille Cedex, France

Received 27 January 2003; received in revised form 21 March 2003; accepted 26 March 2003.

^* Corresponding author. Service d'Oncologie Thoracique, Département des Maladies Respiratoires, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13274 Marseille Cedex 09, France. Tel.: +33-491-74-47-36; fax: +33-491-74-55-24
e-mail: fabrice.barlesi{at}mail.ap-hm.fr

Bronchioloalveolar carcinoma (BAC) of the lung is a subtype of adenocarcinoma with pure bronchoalveolar growth pattern and no evidence of stromal, vascular or pleural invasion (1999 WHO criteria), that seems to increase in incidence actually. BAC has its proper clinical spectrum, occurring more frequently in women and in younger patients. BAC also seems to be less dependent on tobacco exposure. Furthermore, original feature of this type of lung cancer is its intrapulmonary spreading and being infrequently systemic. Thus, surgical resection appears to have a pivotal role. This review of the literature attempted to assess whether or not patients with BAC should be treated according to the same oncological principles as those recommended for other non-small cell lung cancers, i.e. performance of anatomical resection combined with lymphadenectomy, and development of multimodality therapeutic strategies. Unilateral multinodular or pneumonic forms are best removed by lobectomy, or pneumonectomy when appropriate, combined with lymphadenectomy. Segmentectomy or wedge resection is a valuable option for the treatment of solitary lung nodules with pure pathological BAC patterns, provided specific conditions based upon computed tomography scan findings are present. The place of multimodality strategies is still unexplored. Treatment of bilateral BAC is challenging. Incomplete resection may be performed to palliate a severe intrapulmonary shunting. However, one hope of cure is provided by lung transplantation, even though disappointing results with disease recurrence on the grafts have been reported. The lack of large studies including only pure BAC gives a place for future biological and clinical research on this cancer.

Key Words: Bronchioloalveolar carcinoma • Thoracic surgery • Prognosis • Wedge resection • Non-small cell lung cancer • Radiology

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