title: Surgery for bronchioloalveolar carcinoma and "very early" adenocarcinoma: an evolving standard of care?
abstract: Lobectomy and mediastinal lymph node dissection is the standard surgical management of early stage non-small cell lung cancer (NSCLC) because more limited resections have been associated with a higher risk of local recurrence. Nevertheless, recent lung cancer screening studies have led to the detection of an increasing number of "very early" NSCLC (defined as less than 2 cm in size) and of good-prognosis histologic subtypes, bronchioloalveolar carcinoma (BAC), and adenocarcinoma (AC), mixed subtypes that are potentially appropriate for sublobar resection. The precise indications for sublobar resection remain unclear and are the subject of ongoing clinical trials, but it seems that very early, peripherally located, node-negative AC of a predominantly BAC pattern may be adequately treated in this manner. Multifocal AC and BAC, either synchronous or metachronous, are also effectively treated by complete resection, using limited resections whenever possible. The pneumonic form of BAC, the rarest variant of this disease spectrum, continues to have a poor prognosis despite complete resection. Very limited experience suggests that lung transplantation leads to prolonged survival in highly selected patients with this histologic subtype. To improve our management of very early AC, much more information is needed about the molecular abnormalities of AC and their relationship to clinical outcomes.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. ruschv@mskcc.org
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tsuchiya
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuboi
authors.forename: Harvey I
authors.initials: HI
authors.lastname: Pass
authors.forename: Dominique
authors.initials: D
authors.lastname: Grunenwald
authors.forename: Peter
authors.initials: P
authors.lastname: Goldstraw
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017326:Clinical Trials, Phase III as Topic; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008482:Mediastinum; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome