title: Surgical treatment in patient with non-small-cell lung cancer with fissure involvement: anatomical versus nonanatomical resection.
abstract: OBJECTIVE
  Despite the intense debate concerning the prognostic impact of fissure involvement (FI) in patients with non-small-cell lung cancer, no specific surgical strategies have been yet recommended when this condition occurs. In this setting, we report our monocentric 10-years experience to investigate this issue.
  
  
  METHODS
  From January 2000 to January 2010, the clinical data of 40 non-small-cell lung cancer patients with FI undergoing curative resection were retrospectively reviewed. The sample was stratified according to the type of resection: group A (28 patients): anatomical resection (bilobectomy [21 patients], pneumonectomy [7 patients]); group B (12 patients): nonanatomical resection (lobectomy plus wedge resection [LWR]). The end-points were (1) impact of different surgical approach on the pulmonary function (measured before surgery and 1 month after discharge); (2) disease-specific survival; and (3) tumor recurrence.The t test, χ, and log-rank tests, Kaplan-Meier method, and Cox and logistic regression analyses were used for the statistical analysis.
  
  
  RESULTS
  No differences between the two groups were found when comparing the clinical characteristics, histology, pN or pT status, p-stage, residual (R1) disease, tumor grading, or tumor size. Similarly, the baseline preoperative function (tested as forced expiratory volume in 1 second-%-predicted, FEV1%) was likewise comparable (92.5% ± 21.0% in group A versus 85.2% ± 20.0% in group B; p = not significant). The decline of FEV1% after surgery was slightly higher in group A (-24.9% ± 13.5%) when compared with that in group B (-19.5% ± 13.3%), but this difference was not statistically significant (p = ns). Nevertheless, the 5-year disease-specific survival was 56% for group A and 47% for group B (p = ns). The recurrence rate did not differ between the patients undergoing a LWR (3 of 12 patients) and those undergoing a bilobectomy or pneumonectomy (9 of 28 patients) (p = ns). The presence of FI extended for more than 3 cm was found to be the most significant prognostic factor when analyzing survival (p = 0.002) and recurrence rate (p< 0.001).
  
  
  CONCLUSIONS
  Our results suggest that nonanatomical resection (LWR) could be considered as a feasible surgical option (especially in "frail" patients with an extent of FI less than 3 cm) in the light of the similar oncological and functional outcome compared with anatomical resection. Further studies based on larger series are needed to confirm these preliminary data and also to investigate the impact on the postoperative quality of life.
authors.affiliation: *Thoracic Surgery Unit, Presidio Ospedaliero Maggiore-Bellaria, Bologna, Italy; †Department of Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy; ‡IRCCS San Raffaele Pisana, Rome, Italy; §EOC-Thoracic Surgery Unit, Bellinzona, Switzerland; ‖Thoracic Surgery Unit, Arcispedale Santa Maria Nuova, IRCCS Reggio Emilia, Reggio Emilia, Italy; and ¶Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Leuzzi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cesario
authors.forename: Stefano
authors.initials: S
authors.lastname: Cafarotti
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.forename: Valentina
authors.initials: V
authors.lastname: Dall'Armi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Novellis
authors.forename: Rosalia
authors.initials: R
authors.lastname: Romano
authors.forename: Alessandra
authors.initials: A
authors.lastname: Siciliani
authors.forename: Elisa
authors.initials: E
authors.lastname: Meacci
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Granone
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011013:Pneumonectomy / Q000379:methods*; D016016:Proportional Hazards Models