title: Limited resection and two-staged lobectomy for non-small cell lung cancer with ground-glass opacity.
abstract: BACKGROUND
  Lung tumors showing ground-glass opacities on high-resolution computed tomography indicate the presence of inflammation, atypical adenomatous hyperplasia, or localized bronchioloalveolar carcinoma. We adopted a two-staged video-assisted thoracoscopic lobectomy strategy involving completion lobectomy for localized bronchioloalveolar carcinoma with an invasive component according to postoperative pathological examination by permanent section after partial resection.
  
  
  METHODS
  Forty-one patients with undiagnosed small peripheral ground-glass opacity lesions underwent partial resection from 2001 to 2007 in Hokkaido University Hospital. Localized bronchioloalveolar carcinoma was classified according to the Noguchi classification for adenocarcinoma. Malignant lesions other than Noguchi types A and B were considered for completion lobectomy and systemic mediastinal lymphadenectomy. Perioperative data of completion video-assisted thoracoscopic lobectomies were compared with data of 67 upfront video-assisted thoracoscopic lobectomies for clinical stage IA adenocarcinoma performed during the same period.
  
  
  RESULTS
  Postoperative pathological examination revealed 35 malignant and 6 non-malignant diseases. Histologically, all of the malignant diseases were adenocarcinomas of Noguchi type A (n = 7), B (n = 9), C (n = 18), and F (n = 1). Eleven of 19 patients (58%) with Noguchi type C or F underwent two-staged video-assisted thoracoscopic lobectomy. Three patients refused a second surgery. There was no cancer recurrence. The two-staged lobectomy group had a significantly longer operative time and more blood loss than the upfront lobectomy group. There was no surgical mortality or cancer recurrence.
  
  
  CONCLUSIONS
  Two-staged lobectomy for undiagnosed small peripheral ground-glass opacity lesions showed satisfactory oncological results. However, low compliance for and invasiveness of the second surgery are concerns associated with this strategy.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Ohtaka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hida
authors.forename: Kichizo
authors.initials: K
authors.lastname: Kaga
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kato
authors.forename: Jun
authors.initials: J
authors.lastname: Muto
authors.forename: Reiko
authors.initials: R
authors.lastname: Nakada-Kubota
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
mesh_terms: D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011013:Pneumonectomy / Q000379:methods*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed