Top

Published in:

Open Access 01-12-2021 | Lung Cancer | Research

Optimal margins for early stage peripheral lung adenocarcinoma resection

Authors: Pan Yin, Bingqing Yue, Ji Zhang, Dong Liu, Dongyu Bai, Guang Zhao, Chutong Huang, Guojun Geng, Jie Jiang, Yongxiang Su, Xiuyi Yu, Jingyu Chen

Published in: BMC Cancer | Issue 1/2021

Abstract

Background

A pathologically confirmed negative margin is required when performing sublobar resection in patients with early stage peripheral lung adenocarcinoma. However, the optimal margin distance to ensure complete tumor resection while preserving healthy lung tissue remains unknown. We aimed to establish a reliable distance range for negative margins.

Methods

A total of 52 intraoperative para-cancer tissue specimens from patients with peripheral lung adenocarcinoma with pathological tumors ≤2 cm in size were examined. Depending on the distance from the tumor edge (D), the para-cancer tissues were divided into the following five groups: D < 0.5 cm (group I); 0.5 cm ≤ D < 1.0 cm (group II); 1.0 cm ≤ D < 1.5 cm (group III); 1.5 cm ≤ D < 2.0 cm (group IV); and D ≥ 2.0 cm (group V). During pathological examination of the specimens under a microscope, the presence of atypical adenomatous hyperplasia or more severe lesions was considered unsafe, whereas the presence of normal lung tissue or benign hyperplasia was considered safe.

Results

Group V, in which the margin was the farthest from the tumor edge, was the safest. There were significant safety differences in between groups I and V (χ² = 26.217, P < 0.001). Significant safety differences also existed between groups II and V (χ² = 9.420, P < 0.005). There were no significant safety differences between group III or IV and group V (P = 0.207; P = 0.610).

Conclusions

We suggest that when performing sublobar resection in patients with early stage peripheral lung adenocarcinoma with pathological tumor sizes ≤2 cm, the resection margin distance should be ≥1 cm to ensure a negative margin.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.CrossRef

National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409.CrossRef

Moon Y, Lee KY, Park JK. The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection. J Thorac Dis. 2017;9(10):3782–92. https://doi.org/10.21037/jtd.2017.09.40.CrossRefPubMedPubMedCentral

Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest. 2014;145(1):66–71. https://doi.org/10.1378/chest.13-1094.CrossRefPubMed

Tsutani Y, Tsubokawa N, Ito M, Misumi K, Hanaki H, Miyata Y, et al. Postoperative complications and prognosis after lobar resection versus sublobar resection in elderly patients with clinical stage I non-small-cell lung cancer. Eur J Cardio Thorac Surg. 2018;53(2):366–71. https://doi.org/10.1093/ejcts/ezx296.CrossRef

Wang HH, Zhang CZ, Zhang BL, Chen J, Zeng XL, Deng L, et al. Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with stage I non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(4):6033–42. https://doi.org/10.18632/oncotarget.14010.CrossRefPubMed

El-Sherif A, Fernando HC, Santos R, Pettiford B, Luketich JD, Close JM, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol. 2007;14(8):2400–5. https://doi.org/10.1245/s10434-007-9421-9.CrossRefPubMed

Mohiuddin K, Haneuse S, Sofer T, Gill R, Jaklitsch MT, Colson YL, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cancer. J Thorac Cardiovasc Surg. 2014;147(4):1169–75. https://doi.org/10.1016/j.jtcvs.2013.11.056.CrossRefPubMed

Moon Y, Lee KY, Moon SW, Park JK. Sublobar resection margin width does not affect recurrence of clinical n0 non-small cell lung cancer presenting as GGO-predominant nodule of 3 cm or less. World J Surg. 2017;41(2):472–9. https://doi.org/10.1007/s00268-016-3743-3.CrossRefPubMed

10.

Hancock JG, Rosen JE, Antonicelli A, Moreno A, Kim AW, Detterbeck FC, et al. Impact of adjuvant treatment for microscopic residual disease after non-small cell lung cancer surgery. Ann Thorac Surg. 2015;99(2):406–13. https://doi.org/10.1016/j.athoracsur.2014.09.033.CrossRefPubMed

11.

Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10(9):1243–60. https://doi.org/10.1097/JTO.0000000000000630.CrossRefPubMed

12.

Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer study group. Ann Thorac Surg. 1995;60(3):615–22. https://doi.org/10.1016/0003-4975(95)00537-U.CrossRefPubMed

13.

Nakamura K, Saji H, Nakajima R, Okada M, Asamura H, Shibata T, et al. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol. 2010;40(3):271–4. https://doi.org/10.1093/jjco/hyp156.CrossRefPubMed

14.

Suzuki K, Saji H, Aokage K, Watanabe SI, Okada M, Mizusawa J, et al. Comparison of pulmonary segmentectomy and lobectomy: safety results of a randomized trial. J Thorac Cardiovasc Surg. 2019;158(3):895–907. https://doi.org/10.1016/j.jtcvs.2019.03.090.CrossRefPubMed

15.

Altorki NK, Wang X, Wigle D, Gu L, Darling G, Ashrafi AS, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med. 2018;6(12):915–24. https://doi.org/10.1016/S2213-2600(18)30411-9.CrossRefPubMedPubMedCentral

16.

Chow SC, Ng CS. Recent developments in video-assisted thoracoscopic surgery for pulmonary nodule management. J Thorac Dis. 2016;8(S6):S509–16. https://doi.org/10.21037/jtd.2016.03.18.CrossRefPubMedPubMedCentral

17.

Koike T, Koike T, Yoshiya K, Tsuchida M, Toyabe S. Risk factor analysis of locoregional recurrence after sublobar resection in patients with clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013;146(2):372–8. https://doi.org/10.1016/j.jtcvs.2013.02.057.CrossRefPubMed

18.

Masasyesva BG, Tong BC, Brock MV, Pilkington T, Goldenberg D, Sidransky D, et al. Molecular margin analysis predicts local recurrence after sublobar resection of lung cancer. Int J Cancer. 2005;113(6):1022–5. https://doi.org/10.1002/ijc.20683.CrossRefPubMed

19.

Sawabata N, Matsumura A, Ohota M, Maeda H, Hirano H, Nakagawa K, et al. Cytologically malignant margins of wedge resected stage I non-small cell lung cancer. Ann Thorac Surg. 2002;74(6):1953–7. https://doi.org/10.1016/S0003-4975(02)03993-0.CrossRefPubMed

20.

Ko KH, Huang TW, Lee SC, Chang WC, Gao HW, Hsu HH. A simple and efficient method to perform preoperative pulmonary nodule localization: CT-guided patent blue dye injection. Clin Imaging. 2019;58:74–9. https://doi.org/10.1016/j.clinimag.2019.06.015.CrossRefPubMed

21.

McDermott S, Fintelmann FJ, Bierhals AJ, Silin DD, Price MC, Ott HC, et al. Image-guided preoperative localization of pulmonary nodules for video-assisted and robotically assisted surgery. Radiographics. 2019;39(5):1264–79. https://doi.org/10.1148/rg.2019180183.CrossRefPubMed

22.

Sui X, Zhao H, Yang F, Liu G, Hu L, Chen C, et al. Analysis of factors affecting successful microcoil localization for pulmonary nodules. J Surg Res. 2018;224:193–9. https://doi.org/10.1016/j.jss.2017.12.020.CrossRefPubMed

23.

Zhao G, Yu X, Chen W, Geng G, Li N, Liu H, et al. Computed tomography-guided preoperative semi-rigid hook-wire localization of small pulmonary nodules: 74 cases report. J Cardiothorac Surg. 2019;14:149.CrossRef

24.

Sawabata N, Ohta M, Matsumura A, Nakagawa K, Hirano H, Maeda H, et al. Optimal distance of malignant negative margin in excision of non-small cell lung cancer: a multicenter prospective study. Ann Thorac Surg. 2004;77(2):415–20. https://doi.org/10.1016/S0003-4975(03)01511-X.CrossRefPubMed

Title: Optimal margins for early stage peripheral lung adenocarcinoma resection
Authors: Pan Yin
Bingqing Yue
Ji Zhang
Dong Liu
Dongyu Bai
Guang Zhao
Chutong Huang
Guojun Geng
Jie Jiang
Yongxiang Su
Xiuyi Yu
Jingyu Chen
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Lung Cancer
Lung Cancer
Lung Cancer
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08251-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

A composite biomarker of neutrophil-lymphocyte ratio and hemoglobin level correlates with clinical response to PD-1 and PD-L1 inhibitors in advanced non-small cell lung cancers

Low expression of ferritinophagy-related NCOA4 gene in relation to unfavorable outcome and defective immune cells infiltration in clear cell renal carcinoma

Predicting disease progression in advanced non-small cell lung cancer with circulating neutrophil-derived and platelet-derived microparticles

Prognostic value of immune factors in the tumor microenvironment of patients with pancreatic ductal adenocarcinoma

Short-term survival and safety of apatinib combined with oxaliplatin and S-1 in the conversion therapy of unresectable gastric cancer

IMProving care After inherited Cancer Testing (IMPACT) study: protocol of a randomized trial evaluating the efficacy of two interventions designed to improve cancer risk management and family communication of genetic test results

Keynote webinar | Spotlight on antibody–drug conjugates in cancer