Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

Abstract

Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related deaths in the world. Therefore, there is a need to intensify treatments of these tumors. Because stage I NSCLC is a nonmetastatic disease, local therapies are indicated, among which surgery is the most commonly deployed strategy. Pulmonary wedge/sublobar resection is therefore discussed in comparison to stereotactic body radiation therapy for stage I lung cancer. Review of retrospective and prospective clinical trials reveal similar outcomes for both strategies, while a multicenter randomized prospective study comparing the efficacy of both therapies is on-going. Because the results of pulmonary wedge/sublobar resection may depend on tumor size, tumor-distance from surgical margin, tumor size-to-margin distance ratio, and margin cytology, prospective studies to evaluate the clinical implications of these factors, so as to inform patient prognostication, are recommended.

Keywords

Non-small cell lung cancer / wedge resection / sublobar resection / stage I / stereotactic body radiation therapy

References

[1] Masuda M,Okumura M,Arai H,Doki Y,Motomura N,Saiki Y,Tanemoto K,Yokomise H.Thoracic and cardiovascular surgery in Japan during 2012: annual report by The Japanese Association for Thoracic Surgery..Gen Thorac Cardiovasc Surg2014;62:734-64 PMCID:PMC4254159

[2] Goldstraw P,Crowley J,Asamura H,Nicholson AG,Mitchell A.The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer..J Thorac Oncol2016;11:39-51

[3] Fernando HC,Landreneau RJ,Gooding WE,Christie NA,Luketich JD.Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates..J Thorac Cardiovasc Surg2005;129:639-44

[4] Ambrogi MC,Dini P,Davini F,Massimetti G.Wedge resection and radiofrequency ablation for stage I nonsmall cell lung cancer..Eur Respir J2015;45:1089-97

[5] Kawamura M,Tsukada N,Sugiura H,Nakano K,Kuribayashi S.Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates..J Thorac Cardiovasc Surg2006;131:1007-13

[6] Linden PA,Perry Y,Sheng S,Onaitis M.Quantifying the safety benefits of wedge resection: a society of thoracic surgery database propensity-matched analysis..Ann Thorac Surg2014;98:1705-11

[7] Miller JI.Limited resection of bronchogenic carcinoma in the patients with marked impairment of pulmonary function..Ann Thorac Surg1987;44:340-3

[8] Errett LE,Chiu RC.Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients..J Thorac Cardiovasc Surg1985;90:656-61

[9] Landreneau RJ,Mack MJ,Luketich JD,Liptay MJ,Boley TM,Ferson PF,Naunheim KS.Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer..J Thorac Cardiovasc Surg1997;113:691-8

[10] Griffin JP,Tolley EA.Wedge resection for non-small cell lung cancer in patients with pulmonary insufficiency: prospective ten-year survival..J Thorac Oncol2006;1:960-4

[11] Yendamuri S,Correa AM,Wynn B,Hofstetter WL,Roth JA,Vaporciyan AA,Mehran RJ.Comparison of limited surgery and three-dimensional conformal radiation in high-risk patients with stage I non-small cell lung cancer..J Thorac Oncol2007;2:1022-8

[12] Kraev A,Vetto J,Ravichandran P,Kadri A.Wedge resection vs. lobectomy: 10-year survival in stage I primary lung cancer..Chest2007;131:136-40

[13] Grills IS,Welsh R,McInerney E,Wloch J,Kestin LL.Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer..J Clin Oncol2010;28:928-35

[14] El-Sherif A,Santos R,Luketich JD,Landreneau RJ.Margin and local recurrence after sublobar resection of non-small cell lung cancer..Ann Surg Oncol2007;14:2400-5

[15] Wisnivesky JP,Swanson S,Zulueta J,Halm EA.Limited resection for the treatment of patients with stage IA lung cancer..Ann Surg2010;251:550-4

[16] Nakamura H,Miwa K,Fujioka S,Takagi Y.Comparison of the surgical outcomes of thoracoscopic lobectomy, segmentectomy, and wedge resection for clinical stage I non-small cell lung cancer..Thorac Cardiovasc Surg2011;59:137-41

[17] Sawabata N,Matsumura A,Okumura M.Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer..Surg Today2012;42:238-44

[18] Matsuo Y,Hamaji M,Ueki N,Sonobe M,Date H.Comparison of long-term survival outcomes between stereotactic body radiotherapy and sublobar resection for stage I non-small-cell lung cancer in patients at high risk for lobectomy: a propensity score matching analysis..Eur J Cancer2014;50:2932-8

[19] Mediratta N,Page R,Asante-Siaw J.Should males ever undergo wedge resection for stage 1 non-small-cell lung cancer? A propensity analysis..Eur J Cardiothorac Surg2014;46:267-73

[20] Ambrogi MC,Dini P,Davini F,Massimetti G.Wedge resection and radiofrequency ablation for stage I nonsmall cell lung cancer..Eur Respir J2015;45:1089-97

[21] Fiorelli A,Daddi N,Ampollini L,Ventura L,Potenza R,Sollitto F,Puma F,Ragusa M.Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients?.Surg Today2016;46:1370-82

[22] Sawabata N,Asamura H,Eguchi K,Nomori H,Okumura M.Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade..J Thorac Oncol2011;6:1229-35

[23] Sawabata N,Ohota M,Hirano H,Matsuda H.Cytologically malignant margins of wedge resected stage I non-small cell lung cancer..Ann Thorac Surg2002;74:1953-7

[24] Sawabata N,Umezu H,Seki N,Honma K.Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy..Interact Cardiovasc Thorac Surg2008;7:1044-8

[25] Sawabata N,Matsumura A,Hirano H,Matsuda H.Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study..Ann Thorac Surg2004;77:415-20

[26] Maurizi G,Ciccone AM,Andreetti C,Poggi C,Venuta F.Margin distance does not influence recurrence and survival after wedge resection for lung cancer..Ann Thorac Surg2015;100:918-24

[27] Mohiuddin K,Sofer T,Jaklitsch MT,Wee J,Mentzer SJ,Swanson SJ.Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤ 2 cm) non-small cell lung cancer..J Thorac Cardiovasc Surg2014;147:1169-75

[28] Altorki NK,Narula N,Nasar A,Lee PC,Stiles BM.Anatomical segmentectomy and wedge resections are associated with comparable outcomes for patients with small cT1N0 non-small cell lung cancer..J Thorac Oncol2016;11:1984-92

[29] Smith CB,Mhango G.Survival after segmentectomy and wedge resection in stage I non-small-cell lung cancer..J Thorac Oncol2013;8:73-8

[30] Kates M,Wisnivesky JP.Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer ≤ 1 cm in size: a review of SEER data..Chest2011;139:491-6

[31] Yendamuri S,Demmy M,Hennon M,Nwogu C,Demmy T.Temporal trends in outcomes following sublobar and lobar resections for small (≤ 2 cm) non-small cell lung cancers--a Surveillance Epidemiology End Results database analysis..J Surg Res2013;183:27-32

[32] Whitson BA,Andrade RS,Maddaus MA.Invasive adenocarcinoma with bronchoalveolar features: a population-based evaluation of the extent of resection in bronchoalveolar cell carcinoma..J Thorac Cardiovasc Surg2012;143:591-600

[33] Warwick R,Shackcloth M,McShane J,Poullis M.Wedge resection verses lobectomy for stage 1 non-small-cell lung cancer..Asian Cardiovasc Thorac Ann2013;21:566-73

[34] Khullar OV,Gillespie T,Ramalingam S,Fernandez FG.Survival after sublobar resection versus lobectomy for clinical stage IA lung cancer: an analysis from the National Cancer Data Base..J Thorac Oncol2015;10:1625-33

[35] Mery CM,Bueno R,Linden P,Jaklitsch MT.Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database..Chest2005;128:237-45

[36] Stiles BM,Nasar A,Nguyen AB,Port JL.The importance of lymph node dissection accompanying wedge resection for clinical stage IA lung cancer..Eur J Cardiothorac Surg2017;51:511-7

[37] Kodama K,Higashiyama M.Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study..J Thorac Cardiovasc Surg1997;114:347-53

[38] Koike T,Yoshiya K,Suzuki R.Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer..J Thorac Cardiovasc Surg2003;125:924-8

[39] Okada M,Higashiyama M,Kodama K.Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study..J Thorac Cardiovasc Surg2006;132:769-75

[40] Asamura H,Suzuki K,Nakamura K,Nagai K,Mitsudomi T,Shibata T.Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan Clinical Oncology Group 0201..J Thorac Cardiovasc Surg2013;146:24-30

[41] Moon Y,Moon SW.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 Surg2017;41:472-9

[42] Sirzén F,Sörenson S.A systematic overview of radiation therapy effects in non-small cell lung cancer..Acta Oncol2003;42:493-515

[43] Onishi H,Shirato H,Hiraoka M,Yamashita T,Karasawa K,Takai Y,Hirokawa Y,Ouchi A,Kokubo M,Itami J.Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study..Cancer2004;101:1623-31

[44] Davis JN,Sharma S,Pablo J,McKellar H,Chomiak PN.Stereotactic body radiotherapy for early-stage non-small cell lung cancer: clinical outcomes from a National Patient Registry..J Radiat Oncol2015;4:55-63 PMCID:PMC4348495

[45] Shibamoto Y,Baba F,Miyakawa A,Takaoka T,Asai R.Stereotactic body radiotherapy using a radiobiology-based regimen for stage I non-small-cell lung cancer: five-year mature results..J Thorac Oncol2015;10:960-4

[46] Hamaji M,Matsuo Y,Morita S,Sonobe M,Hiraoka M.Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer..Ann Thorac Surg2015;99:1122-9

[47] Bhandari RP,Packianathan S,Kanakamedala MR,Giri SP,Harrell LM,Yang C.Stereotactic body radiation therapy for stage I non-small cell lung cancer: a retrospective, single-center study of 55 patients..Oncology2016;91:194-204

[48] Lischalk JW,Kataria S,Paydar I,Anderson ED.Long-term outcomes of stereotactic body radiation therapy (SBRT) with fiducial tracking for inoperable stage I non-small cell lung cancer (NSCLC)..J Radiat Oncol2016;5:379-87 PMCID:PMC5149392

[49] Puri V,Bell JM,Morgensztern D,Kreisel D,Patterson GA,Patel A.Treatment outcomes in stage I lung cancer: a comparison of surgery and stereotactic body radiation therapy..J Thorac Oncol2015;10:1776-84 PMCID:PMC4695298

[50] Ricardi U,Filippi AR,Levis M,Salvi F,Trovò M,Corvò R.Stereotactic ablative radiotherapy for stage I histologically proven non-small cell lung cancer: an Italian multicenter observational study..Lung Cancer2014;84:248-53

[51] Onishi H,Nagata Y,Fujino M,Karasawa K,Niibe Y,Kimura T,Ouchi A,Kokubo M,Arimoto T,Itami J.Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery?.Int J Radiat Oncol Biol Phys2011;81:1352-8

[52] Kastelijn EA,Hofman FN,Monninkhof EM,Schramel FM.Clinical outcomes in early-stage NSCLC treated with stereotactic body radiotherapy versus surgical resection..Anticancer Res2015;35:5607-14

[53] Rosen JE,Wang Z,Decker RH,Detterbeck FC.Lobectomy versus stereotactic body radiotherapy in healthy patients with stage I lung cancer..J Thorac Cardiovasc Surg2016;152:44-54

[54] Ezer N,Mhango G,Powell CA.Outcomes after stereotactic body radiotherapy versus limited resection in older patients with early-stage lung cancer..J Thorac Oncol2015;10:1201-6 PMCID:PMC4511922

[55] Ginsberg RJ.Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group..Ann Thorac Surg1995;60:615-22

[56] Nakamura K,Nakajima R,Asamura H,Nakamura S,Tsuboi M.A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L)..Jpn J Clin Oncol2010;40:271-4

[57] Suzuki K,Mizusawa J,Yoshino I,Mizutani T,Tada H.Predictors of non-neoplastic lesions in lung tumours showing ground-glass opacity on thin-section computed tomography based on a multi-institutional prospective study..Interact Cardiovasc Thorac Surg2015;21:218-23

[58] Aokage K,Hishida T,Saji H,Suzuki K,Asamura H.Limited resection for early-stage non-small cell lung cancer as function-preserving radical surgery: a review..Jpn J Clin Oncol2017;47:7-11

[59] NCT00499330. Phase III randomized study of lobectomy versus sublobar resection in patients with small peripheral stage IA non-small cell lung cancer. Available from: https://www.georgiacancerinfo.org/clinical-trials/lung-cancer/2591. [Last accessed on 28 Mar 2017].

[60] Fernando HC,Mandrekar SJ,Hillman SL,Meyers BF,Jones DR,Tan AD,Putnam JB, Jr.Impact of brachytherapy on local recurrence rates after sublobar resection: results from ACOSOG Z4032 (Alliance), a phase III randomized trial for high-risk operable non-small-cell lung cancer..J Clin Oncol2014;32:2456-62 PMCID:PMC4121503

[61] Takahashi N,Kawamura M,Horio H,Nakayama M,Chida M.Multicenter prospective study of sublobar resection for c-stage I non-small cell lung cancer patients unable to undergo lobectomy (KLSG-0801): complete republication..Gen Thorac Cardiovasc Surg2016;64:470-5

[62] Timmerman R,Galvin J,Straube W,Fakiris A,Videtic G,Fowler J,Choy H.Stereotactic body radiation therapy for inoperable early stage lung cancer..JAMA2010;303:1070-6 PMCID:PMC2907644

[63] Nagata Y,Shibata T,Kokubo M,Shioyama Y,Kozuka T,Saito T,Hareyama M,Hayakawa K,Ishikura S.Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 non-small cell lung cancer: Japan Clinical Oncology Group Study JCOG0403..Int J Radiat Oncol Biol Phys2015;93:989-96

[64] Chang JY,Paul MA,Louie AV,Groen HJ,Widder J,van den Borne BE,Hurkmans C,van Werkhoven E,Dingemans AM,Haasbeek CJ,De Jaeger K,Slotman BJ,Roth JA.Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials..Lancet Oncol2015;16:630-7

[65] Fernando HC.American College of Surgeons Oncology Group Z4099/Radiation Therapy Oncology Group 1021: a randomized study of sublobar resection compared with stereotactic body radiotherapy for high-risk stage I non-small cell lung cancer..J Thorac Cardiovasc Surg2012;144:S35-8 PMCID:PMC5760167

[66] Timmerman R,Yiannoutsos C,Tudor K,Ewing M,DesRosiers C,Fletcher J.Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer..J Clin Oncol2006;24:4833-9

[67] Sawabata N,Maeda H,Yamaguchi T,Itho M.Diagnosis of solitary pulmonary nodule: optimal strategy based on nodal size..Interact Cardiovasc Thorac Surg2006;5:105-8

[68] Sawabata N,Maeda H.Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract..Chest2001;120:1595-8

[69] Inoue M,Tomiyama N,Sawabata N,Shintani Y,Okumura M.Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients..Ann Thorac Surg2011;91:1066-71

[70] Kashiwabara K,Fujii S.Preoperative percutaneous transthoracic needle biopsy increased the risk of pleural recurrence in pathological stage I lung cancer patients with sub-pleural pure solid nodules..Cancer Invest2016;34:373-7

[71] Sawabata N,Ohta M.Operable non-small cell lung cancer diagnosed by transpleural techniques: do they affect relapse and prognosis?.Chest2001;120:1595-8

[72] Nakajima J,Takamoto S.Does preoperative transbronchial biopsy worsen the postsurgical prognosis of lung cancer? A propensity score-adjusted analysis..Chest2005;128:3512-8

[73] Hattori A,Takamochi K,Suzuki K.Neither maximum tumor size nor solid component size is prognostic in part-solid lung cancer: impact of tumor size should be applied exclusively to solid lung cancer..Ann Thorac Surg2016;102:407-15

[74] Tsurugai Y,Ishizuka N.Relationship between the consolidation to maximum tumor diameter ratio and outcomes following stereotactic body radiotherapy for stage I non-small-cell lung cancer..Lung Cancer2016;92:47-52

[75] The prospective observational study of lung wedge resection for cT1a,1bN0M0 non-small lung cancer patients. Available from: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000027991&type=summary&language=J. [Last Accessed on 8 Jan 2017].