[Indication of limited pulmonary resection for small-sized lung cancer based on preoperative clinical data].
Limited pulmonary resection is performed mostly based on the size of lung cancer and ground-glass opacity (GGO). It has been proposed to determine the indication of segmentectomy according to hilar lymph node involvement. There is a potential risk of underestimation for lymph node involvement since there may be a skip mediastinal lymph node metastasis without hilar involvement. We propose to use standardized uptake value( SUV) max of primary lung cancer as an indicator of non-invasive lung cancer. None of 44 small-sized lung cancers with SUVmax lower than 1 had lymph node metastasis or vessel invasion. A small-sized lung cancer ≤ 2 cm with SUVmax ≤ 1 is indicated wedge resection if GGO area is greater than 75% of tumor. Segmentectomy is indicated if the GGO area is less than 75%. We also propose selective lymphadenectomy for small-sized lung cancer. The lower mediastinal lymphadenectomy may be omitted if a small-sized tumor is located in the right upper lobe or the left upper segment. The upper mediastinal lymphadenectomy may be omitted if a small-sized lung cancer is located in the lower lobe and if the lower mediastinal lymph node involvement is excluded.
Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Sapporo, Japan.
Yasuhiro
Y
Hida
Koichi
K
Teramura
Jun
J
Muto
Kazuto
K
Ohtaka
Ryunosuke
R
Hase
Reiko
R
Nakada
Yusuke
Y
Watanabe
Yoshiro
Y
Matsui
Kichizo
K
Kaga
D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D011013:Pneumonectomy / Q000379:methods*