title: Surgical procedures in the DANTE trial, a randomized study of lung cancer early detection with spiral computed tomography: comparative analysis in the screening and control arm.
abstract: BACKGROUND
  The patient population derived from lung cancer screening programs with low-dose spiral computed tomography (LDCT) is different from the general population accessing thoracic surgical services.
  
  
  METHODS
  Retrospective review of all surgical cases in the DANTE trial, a randomized study of lung cancer screening with LDCT. Patient characteristics, workup, procedures, resections for benign disease, complications, tumor features, and final outcomes have been analyzed in the LDCT and in the control arm.
  
  
  RESULTS
  In the LDCT arm, 77 suspicious lesions were surgically managed in 72 patients. A benign lesion was diagnosed in 17 cases (22%). Major video-assisted thoracoscopic surgery resection was carried out in five lung cancer cases (7%) and segmentectomy in 11 (19%). Complete resection was achieved in 93%, and stage I rate was 73%. Two patients had a local recurrence after open lobectomy, and three had a resectable new primary. In the control group, 28 patients underwent 31 surgical procedures, in five cases (16%) for benign lesions. No major video-assisted thoracoscopic surgery resections were carried out. Resectability rate was 88%, and stage I rate was 52%. Five patients had a local recurrence and two had a second primary.
  
  
  CONCLUSIONS
  Surgery for benign lesions is a relevant issue in screening-derived patients. Local control may be achieved by minimally invasive techniques or segmentectomy; however, developing the necessary skills requires an effort by the surgical team. Long-term survivors have a noticeable chance of developing second primary cancers or resectable recurrences and may benefit from a second resection.
authors.affiliation: Thoracic Surgery Department, IRCCS Istituto Clinico Humanitas, Rozzano (Milano), Italy. maurizio.infante@humanitas.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Infante
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chiesa
authors.forename: Daniel
authors.initials: D
authors.lastname: Solomon
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morenghi
authors.forename: Eliseo
authors.initials: E
authors.lastname: Passera
authors.forename: Fabio Romano
authors.initials: FR
authors.lastname: Lutman
authors.forename: Edoardo
authors.initials: E
authors.lastname: Bottoni
authors.forename: Umberto
authors.initials: U
authors.lastname: Cariboni
authors.forename: Valentina
authors.initials: V
authors.lastname: Errico
authors.forename: Emanuele
authors.initials: E
authors.lastname: Voulaz
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ferraroli
authors.forename: Alberto
authors.initials: A
authors.lastname: Testori
authors.forename: Francesco
authors.initials: F
authors.lastname: Inzirillo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Chiarenza
authors.forename: Massimo
authors.initials: M
authors.lastname: Roncalli
authors.forename: Silvio
authors.initials: S
authors.lastname: Cavuto
authors.forename: Arturo
authors.initials: A
authors.lastname: Chiti
authors.forename: Marco
authors.initials: M
authors.lastname: Alloisio
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ravasi
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D055088:Early Detection of Cancer; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D036542:Tomography, Spiral Computed