Surgical Management of Non-Small Cell Lung Cancer Invading the Fissure: Less Is More?

Publication Title

The Annals of thoracic surgery

Authors

Shane P Smith, Swedish Medical Center and Cancer Institute, Division of Thoracic Surgery, 1101 Madison St, Suite 900, Seattle, WA 98104Follow
Adam J Bograd, Swedish Medical Center and Cancer Institute, Division of Thoracic Surgery, 1101 Madison St, Suite 900, Seattle, WA 98104Follow
Gal Levy, Swedish Medical Center and Cancer Institute, Division of Thoracic Surgery, 1101 Madison St, Suite 900, Seattle, WA 98104
Shu-Ching Chang, Providence - St. Joseph Health, Medical Data Research Center, 9427 SW Barnes Road, Suite 594, Portland, OR 97225Follow
Alexander S Farivar, Swedish Medical Center and Cancer Institute, Division of Thoracic Surgery, 1101 Madison St, Suite 900, Seattle, WA 98104Follow
Ralph W Aye, Swedish Medical Center and Cancer Institute, Division of Thoracic Surgery, 1101 Madison St, Suite 900, Seattle, WA 98104Follow
Brian Louie, Swedish Medical Center and Cancer Institute, Division of Thoracic Surgery, 1101 Madison St, Suite 900, Seattle, WA 98104Follow
Eric Vallieres, Swedish Medical Center and Cancer Institute, Division of Thoracic Surgery, 1101 Madison St, Suite 900, Seattle, WA 98104Follow

Document Type

Article

Publication Date

7-9-2020

Abstract

BACKGROUND: When encountering a resectable lung cancer that invades across the fissure into an adjacent lobe, options include a bilobectomy on the right or a pneumonectomy on the left versus a parenchymal sparing resection combined with a lobectomy. Though parenchymal sparing combinations are technically possible, the available literature reporting on the related oncological outcomes is limited. We sought to examine the influence of resection extent on overall survival and recurrence patterns in this scenario.

METHODS: A single center retrospective chart review from 2006-2018 was performed on all preoperative computed tomography and operative reports of resections greater than a lobectomy. Patients were grouped into maximal resection: bilobectomy or pneumonectomy, and parenchymal sparing resection: lobectomy with en bloc segment or non-anatomical wedge. Overall survival and cumulative incidence of recurrence were calculated.

RESULTS: The size of our cohort was 54 patients; 19 maximal and 35 parenchymal sparing resections. All resections were reported as complete (R0). The parenchymal sparing group had lower odds of immediate surgical morbidity [OR=0.13; 95% CI= (0.02, 0.74); p=0.02]. Parenchymal sparing was not associated with an increased cumulative incidence of recurrence (p = 0.98). Post-resection estimated overall survival between the two cohorts was not significantly different (p = 0.30).

CONCLUSIONS: When technically feasible, a parenchymal sparing resection is a good option for the resection of tumors that invade across the fissure. R0 parenchymal sparing resections do not appear to compromise the oncologic outcomes of either overall survival or cumulative incidence of recurrence and also seem to carry be less morbidity.

Area of Special Interest

Cancer

Specialty/Research Institute

Swedish Thoracic Surgery

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery