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

Document Type


Publication Date


Publication Title

The Annals of thoracic surgery


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.

Clinical Institute



Swedish Thoracic Surgery