Feasibility of segmental resection in non-small-cell lung cancer with ground-glass opacity

Abstract

Objectives: Recently, lung segmental resection has been increasingly performed in patients with lung cancer. In this study, the results of radical segmentectomy (RS) and palliative segmentectomy (PS) were compared retrospectively.

Methods: Segmentectomy was performed to remove a primary lung cancer in 87 cases. RS was performed for pure ground-glass opacity (GGO), >50% GGO and diameter less than 2 cm and less than 10 mm solid tumours. PS was performed in patients with poor lung function or relapse, or at high risk for surgery. A total of 84 cases, excluding 3 cases of relapse, were investigated.

Results: The pathological stage of RS was IA in 32 (94.1%) and IB in 2 (5.9%). The pathological stage of PS was IA in 23 (46.0%), IB in 15 (30.0%), IIA in 5 (10.0%), IIB in 1 (2.0%), IIIA in 4 (8.0%) and IV in 2 (4.0%). The preoperative characteristics of RS were compared with those of PS for pathological stage I. The mean age was significantly lower for RS cases (67.4 ± 9.9 years) than for PS cases (73.0 ± 9.0 years; P = 0.013). Tumour size was significantly smaller in RS cases (14.7 ± 4.6 mm) than in PS cases (22.0 ± 8.9 mm; P < 0.001). The tumour standardized uptake value of 18F-fluorodeoxyglucose positron emission tomography was significantly lower in RS cases (1.2 ± 1.6) than in PS cases (6.0 ± 6.1; P < 0.001). Serum carcinoembryonic antigen level was lower in RS cases (2.8 ± 1.8 ng/ml) than in PS cases (4.9 ± 5.0; P = 0.019). The mean duration of drainage was shorter in RS (2.5 ± 0.7 days) than in PS (3.9 ± 2.6 days; P = 0.004). Postoperative complications occurred in 6 RS cases (17.6%) and 12 PS cases (29.3%). Overall 5-year survival was higher in RS (100%) than in PS (66.2%; P = 0.003). Five-year disease-free survival was higher in RS (100%) than in PS (66.2%; P = 0.002). Recurrence was detected in 6 PS patients; 10 PS cases showed tumour with GGO and survived without recurrence.

Conclusions: Our RS is feasible for stage I lung cancer with specific computed tomography features, such as small size, GGO or peripheral location.

Keywords: Ground-glass opacity; Lung segmentectomy; Small-size lung cancer.