J Chest Surg.  2021 Oct;54(5):361-368. 10.5090/jcs.21.045.

Long-Term Outcomes in Stage I Lung Cancer After Segmentectomy with a Close Resection Margin

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
  • 2Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 3Seoul National University Cancer Research Institute, Seoul, Korea

Abstract

Background
In general, a 2-cm surgical margin is recommended for limited resection to obtain equivalent oncologic outcomes to lobectomy for lung cancer. This study aimed to examine the patterns of recurrence and prognostic factors for recurrence in patients with a close parenchymal resection margin.
Methods
From January 2009 to April 2017, 156 patients with stage I lung cancer who underwent segmentectomy with a close resection margin (<2 cm) were enrolled. Recurrence- free survival and overall survival were assessed. In addition, predisposing factors for recurrence were evaluated.
Results
The mean tumor size was 1.7±0.8 cm and the parenchymal resection margin was 1.1±0.6 cm. Recurrence developed in 17 (10.7%) of the 156 patients, and the 5-year recurrence-free survival rate was 88.9%. Distant metastasis (7.7%) was the predominant recurrence pattern. The isolated local recurrence rate was 1.9%. Multivariate Cox regression analysis revealed that age, tumor size, mediastinal lymph node dissection, postoperative complications, and histologic type were significant predisposing factors for recurrence. However, parenchymal margin distance did not significantly affect the long-term prognosis.
Conclusion
Segmentectomy with a close resection margin for early-stage lung cancer in selected patients resulted in acceptable recurrence and survival. However, patients with tumors larger than 2 cm, squamous cell carcinoma histology, and insufficient mediastinal evaluation should be carefully followed up for recurrence.

Keyword

Lung neoplasms; Segmentectomy; Resection margin; Recurrence
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