Margin and local recurrence after sublobar resection of non-small cell lung cancer

Ann Surg Oncol. 2007 Aug;14(8):2400-5. doi: 10.1245/s10434-007-9421-9. Epub 2007 May 16.


Background: Local recurrence is a major concern after sublobar resection (SR) of non-small cell lung cancer (NSCLC). We postulate that a large proportion of local recurrence is related to inadequate resection margins. This report analyzes local recurrence after SR of stage I NSCLC. Stratification based on distance of the tumor (<1 cm vs >or=1 cm) to the staple line was performed.

Methods: We reviewed 81 NSCLC patients (44 female) who underwent operation over an 89-month period (January 1997 to June 2004). Mean forced expiratory volume in one second percentiles (FEV1) was 57%. Mean age was 70 (46-86) years. There were 55 wedge and 26 segmental resections. There were 41 tumors with a margin <1 cm and 40 with a margin >or=1 cm. Local recurrence was defined as recurrence within the ipsilateral lung or pulmonary hilum.

Results: There were no perioperative deaths. Mean follow-up was 20 months. Margin distance significantly impacted local recurrence; 6 of 41 patients (14.6%) developed local recurrence in the group with margin less than 1 cm versus 3 of 40 patients (7.5%) in the group with margin equal to or more than 1 cm (P = .04). Of the 41 patients with margins <1 cm, segmentectomy was used in 7 (17%), whereas in the 40 patients with the >or=1 cm margins, segmentectomy was used in 19 (47.5%).

Conclusions: Margin is an important consideration after SR of NSCLC. Wedge resection is frequently associated with margins less than 1 cm and a high risk for locoregional recurrence. Segmentectomy appears to be a better choice of SR when this is chosen as therapy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / physiopathology
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Humans
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Staging
  • Radiography, Thoracic
  • Retrospective Studies
  • Survival Analysis
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome