Limited Resection for Lung Cancer

Tsubota, Noriaki

Abstract

Lesser resection than lobectomy for lung cancer has been discussed for years and there has been world consensus in that the indication is only acceptable for compromised patients. However, the present wide use of high resolution computed tomography (HRCT) has resulted in an increased detection of tumors less than two centimeters in diameter. In spite of a randomized study reported by LCSG in 1995, which concluded that intentional limited resection was inferior to standard lobectomy, studies supporting the use of limited resection for early cancer continue to be published, especially from Japan, and currently even from the US. Improved surgical technique that allows the identification of the intersegmental plane has facilitated the application of segmentectomy beyond an affected segment with wide margin, which decreases the risk of local recurrence. The ratio of characteristic tumor shadow with ground glass opacity (GGO) to whole tumor size on HRCT is a good indicator of malignancy. In selected patients with a small-sized peripheral tumor with 100% GGO can be removed even with wedge resection. It is time to start a randomized, large series trial of patients with a peripheral tumor less than 2 cm, and in the near future, subsets of patients who could be successfully treated by sublobar resection should be identified