Extent of surgical resection for radiologically subsolid T1N0 invasive lung adenocarcinoma: When is a wedge resection acceptable?

Chao Zhang; Yunjian Pan; Hang Li; Yang Zhang; Bin Li; Yiliang Zhang; Xiaoyang Luo; Longsheng Miao; Longfei Ma; Sufeng Chen; Hong Hu; Yihua Sun; Yawei Zhang; Jiaqing Xiang; Shengping Wang; Yajia Gu; Yuan Li; Xuxia Shen; Zezhou Wang; Ting Ye; Haiquan Chen

doi:10.1016/j.jtcvs.2023.06.010

Extent of surgical resection for radiologically subsolid T1N0 invasive lung adenocarcinoma: When is a wedge resection acceptable?

J Thorac Cardiovasc Surg. 2024 Mar;167(3):797-809.e2. doi: 10.1016/j.jtcvs.2023.06.010. Epub 2023 Jun 27.

Authors

Chao Zhang¹, Yunjian Pan¹, Hang Li¹, Yang Zhang¹, Bin Li¹, Yiliang Zhang¹, Xiaoyang Luo¹, Longsheng Miao¹, Longfei Ma¹, Sufeng Chen¹, Hong Hu¹, Yihua Sun¹, Yawei Zhang¹, Jiaqing Xiang¹, Shengping Wang², Yajia Gu², Yuan Li³, Xuxia Shen³, Zezhou Wang⁴, Ting Ye⁵, Haiquan Chen⁶

Affiliations

¹ Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Fudan University, Shanghai, China.
² Department of Oncology, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
³ Department of Oncology, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.
⁴ Department of Oncology, Fudan University, Shanghai, China; Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China.
⁵ Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Fudan University, Shanghai, China. Electronic address: yeting831011@hotmail.com.
⁶ Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Fudan University, Shanghai, China. Electronic address: hqchen1@yahoo.com.

PMID: 37385528
DOI: 10.1016/j.jtcvs.2023.06.010

Abstract

Objective: To evaluate whether wedge resection (WR) was appropriate for the patients with peripheral T1 N0 solitary subsolid invasive lung adenocarcinoma.

Methods: Patients with peripheral T1N0 solitary subsolid invasive lung adenocarcinoma who received sublobar resection were retrospectively reviewed. Clinicopathologic characteristics, 5-year recurrence-free survival, and 5-year lung cancer-specific overall survival were analyzed. Cox regression model was used to elucidate risk factors for recurrence.

Results: Two hundred fifty-eight patients receiving WR and 1245 patients receiving segmentectomy were included. The mean follow-up time was 36.87 ± 16.21 months. Five-year recurrence-free survival following WR was 96.89% for patients with ground-glass nodule (GGN) ≤2 cm and 0.25< consolidation-to-tumor ratio (CTR) ≤0.5, not statistically different from 100% for those with GGN≤2 cm and CTR ≤0.25 (P = .231). The 5-year recurrence-free survival was 90.12% for patients with GGN between 2 and 3 cm and CTR ≤0.5, significantly lower than that of patients with GGN ≤2 cm and CTR ≤0.25 (P = .046). For patients with GGN≤2 cm and 0.25<CTR≤0.5, 5-year recurrence-free survival and lung cancer-specific overall survival were 97.87% and 100% following WR versus 97.73% and 92.86% following segmentectomy (recurrence-free survival: P = .987; lung cancer-specific overall survival: P = .199), respectively. For patients with GGN between 2 and 3 cm and CTR ≤0.5, 5-year recurrence-free survival following WR was significantly lower than that following SEG (90.61% vs 100%; P = .043). Multi-variable Cox regression analysis showed that spread through airspace, visceral pleural invasion, and nerve invasion remained independent risk factors for recurrence of patients with GGN between 2 and 3 cm and CTR ≤0.5 following WR.

Conclusions: WR might be appropriate for patients with invasive lung adenocarcinoma appearing as peripheral GGN ≤2 cm and CTR ≤0.5, but inappropriate for those with invasive lung adenocarcinoma appearing as peripheral GGN between 2 and 3 cm and CTR ≤0.5.

Keywords: lung invasive adenocarcinoma; segmentectomy; sublobar resection; subsolid nodule; wedge resection.

MeSH terms

Adenocarcinoma of Lung* / diagnostic imaging
Adenocarcinoma of Lung* / surgery
Humans
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / surgery
Neoplasm Staging
Pneumonectomy / adverse effects
Retrospective Studies