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J Thorac Cardiovasc Surg 2006;132:769-775
© 2006 The American Association for Thoracic Surgery
General Thoracic Surgery |
a Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi City, Hyogo, Japan
b Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata City, Niigata, Japan
c Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan.
Received for publication December 9, 2005; accepted for publication February 6, 2006. * Address for reprints: Morihito Okada, MD, PhD, Department of Thoracic Surgery, Hyogo Medical Center for Adults, Kitaohji-cho13-70, Akashi City 673-8558, Hyogo, Japan. (Email: morihito1217jp{at}aol.com).
Objective: At present, even when early-stage, small-sized non–small cell lung cancers are being increasingly detected, lesser resection has not become the treatment of choice. We sought to compare sublobar resection (segmentectomy or wedge resection) with lobar resection to test which one is the appropriate procedure for such lesions.
Methods: From 1992 to 2001, a nonrandomized study was performed in 3 institutes for patients with a peripheral cT1N0M0 non–small cell lung cancer of 2 cm or less who were able to tolerate a lobectomy. The results of the sublobar resection group enrolled preoperatively (n = 305) were compared with those of the lobar resection group (n = 262).
Results: Except for distribution of tumor location, there were no significant differences in any variable, patient characteristics, curability, pathologic stage, morbidity, or recurrence rate. Median follow-up was more than 5 years. Disease-free and overall survivals were similar in both groups with 5-year survivals of 85.9% and 89.6% for the sublobar resection group and 83.4% and 89.1% for the lobar resection group, respectively. Multivariate analysis confirmed that the recurrence rate and prognosis associated with sublobar resection were not inferior to those obtained with lobar resection. Postoperative lung function was significantly better in patients who underwent sublobar resection.
Conclusions: Sublobar resection should be considered as an alternative for stage IA non–small cell lung cancers 2 cm or less, even in low-risk patients. These results could lay the foundation for starting randomized controlled trials anew, which would bring great changes of lung cancer surgery in this era of early detection of lung cancer.
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