title: Segmentectomy for selected cT1N0M0 non-small cell lung cancer: a prospective study at a single institute.
abstract: BACKGROUND
  To examine whether segmentectomy is radical for cT1N0M0 non-small cell lung cancer (NSCLC), a prospective single-arm study was performed at a single institution.
  
  
  METHODS
  The criteria for segmentectomy were as follows: (1) peripheral-type cT1N0M0 NSCLC; (2) intraoperative frozen sections of sentinel nodes identified with isotope showing no metastasis; (3) surgical margins greater than 2 cm; (4) patient choice for segmentectomy; and (5) exclusion of right middle lobe tumors. From 2005 to 2009, of 245 patients with cT1N0M0 NSCLC, 195 (80%) were enrolled in the present study. Of these 195 patients, 179 ultimately underwent segmentectomy with systematic lymph node dissection. Of these 179 patients, 134 (75%) had tumors 2 cm or smaller, and 45 (25%) had tumors 2.1 cm to 3 cm. The median follow-up period was 43 months.
  
  
  RESULTS
  All 181 tumors from 179 patients were stage pN0. Of the 179 patients, 6 developed distant site recurrence and 3 local recurrence (ie, 1 developed pulmonary metastases within the same lobe 21 months after segmentectomy and 2 developed local recurrence at the surgical margin 60 and 62 months after segmentectomy, respectively). The 5-year overall survival was 94% for patients with tumors 2 cm or smaller and 81% for those with 2.1-cm to 3-cm tumors. Postoperative pulmonary function was preserved at 90% ± 12% of preoperative levels.
  
  
  CONCLUSIONS
  Segmentectomy with systematic lymph node dissection with a sufficient surgical margin could be a radical treatment for selected cT1N0M0/pN0 NSCLC while preserving pulmonary function. The surgical margin should be monitored for the development of local recurrence for a long period after segmentectomy.
authors.affiliation: Division of General Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan. hnomori@qk9.so-net.ne.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nomori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mori
authors.forename: Koei
authors.initials: K
authors.lastname: Ikeda
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshimoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Iyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012129:Respiratory Function Tests; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D016896:Treatment Outcome