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Margin and Local Recurrence After Sublobar Resection of Non-Small Cell Lung Cancer

¹ Division of Thoracic Surgery and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
² Department of Cardiothoracic Surgery, Boston Medical Center, Boston, Massachusetts, USA
³ Department of Dental Public Health and Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Correspondence: Address correspondence and reprint requests to: Rodney J. Landreneau, MD; E-mail: landreneaurj{at}upmc.edu

Background: Local recurrence is a major concern after sublobar resection (SR) of non-small cell lung cancer (NSCLC). We postulate that a large proportion of local recurrence is related to inadequate resection margins. This report analyzes local recurrence after SR of stage I NSCLC. Stratification based on distance of the tumor (<1 cm vs 1 cm) to the staple line was performed.

Methods: We reviewed 81 NSCLC patients (44 female) who underwent operation over an 89-month period (January 1997 to June 2004). Mean forced expiratory volume in one second percentiles (FEV1) was 57%. Mean age was 70 (46–86) years. There were 55 wedge and 26 segmental resections. There were 41 tumors with a margin <1 cm and 40 with a margin 1 cm. Local recurrence was defined as recurrence within the ipsilateral lung or pulmonary hilum.

Results: There were no perioperative deaths. Mean follow-up was 20 months. Margin distance significantly impacted local recurrence; 6 of 41 patients (14.6%) developed local recurrence in the group with margin less than 1 cm versus 3 of 40 patients (7.5%) in the group with margin equal to or more than 1 cm (P = .04). Of the 41 patients with margins <1 cm, segmentectomy was used in 7 (17%), whereas in the 40 patients with the 1 cm margins, segmentectomy was used in 19 (47.5%).

Conclusions: Margin is an important consideration after SR of NSCLC. Wedge resection is frequently associated with margins less than 1 cm and a high risk for locoregional recurrence. Segmentectomy appears to be a better choice of SR when this is chosen as therapy.

Key Words: Non-small cell lung cancer • Tumor recurrence • Sublobar resection • Surgery

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