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Treatment strategy for patients with small peripheral lung lesion(s): intermediate-term results of prospective study

^a Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
^b Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
^c Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

Received 1 June 2008; received in revised form 19 July 2008; accepted 21 July 2008.

^_* Corresponding author. Address: Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. Tel.: +81 6 6972 1181; fax: +81 6 6981 8055. (Email: kodama-ke{at}mc.pref.osaka.jp).

Background: This prospective study was undertaken to establish a novel management algorithm using new indicators to decide the type of lung resection for small peripheral lung lesions. Methods: Inclusion criteria were: (1) 20 mm peripheral lung lesion(s) and (2) absence of significant lymph node swelling on preoperative CT. Along with the conventional criteria, the percentage of ground-glass opacity (GGO) (50% as GGO type and <50% as solid type) on high-resolution CT scan was employed. In accordance with such indicators, a wide wedge resection (WWR), segmentectomy or lobectomy was planned for individual patients. The primary endpoint was to estimate the effectiveness of limited resection in patients with lung cancer by analyzing their locally disease-free survival rates at 5 and 10 years. Results: Of 179 patients enrolled between 1997 and 2002, 90 were male and 89 female. They were divided into 77 GGO types and 102 solid types. During surgery, conversions from limited resections to standard operations were performed on six patients to avoid the risk of local-regional recurrence. Finally, WWR was performed on 73 patients, segmentectomy on 26 and lobectomy on 80, respectively. There were 138 lung cancers and 41 non-cancers. Of 138 cancer patients, 114 patients are alive and 24 died. There were no local-regional recurrences among the 58 cancer patients who underwent limited resection. Conclusions: This intermediate-term outcome suggests that the selection of the type for lung resection using this management algorithm for small peripheral lung lesions was effective for preventing both local-regional recurrences and the excessive resection of normal lung tissue.

Key Words: Lung cancer • Ground-glass opacity • Peripheral lung lesion • Bronchioloalveolar carcinoma • Limited resection