title: Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cancer.
abstract: OBJECTIVE
  Successful pulmonary wedge resection for early-stage non-small cell lung cancer requires a pathologically confirmed negative margin. To date, however, no clear evidence is available regarding whether an optimal margin distance, defined as the distance from the primary tumor to the closest resection margin, exists. Toward addressing this gap, we investigated the relationship between the margin distance and local recurrence risk.
  
  
  METHODS
  We reviewed all adult patients who had undergone wedge resection for small (≤2 cm) non-small cell lung cancer from January 2001 to August 2011, with follow-up through to December 31, 2011. The exclusion criteria included other active noncutaneous malignancies, bronchoalveolar carcinomas, lymph node or distant metastases at diagnosis, large cell cancer, adenosquamous cancer, multiple, multifocal, and/or metastatic disease, and previous chemotherapy or radiotherapy. Using Cox regression analysis, we examined the relationship between the margin distance and interval to local recurrence, adjusting for chronic obstructive pulmonary disease, forced expiratory volume in 1 second, smoking, diabetes, tumor size, tumor location, surgeon, open versus video-assisted thoracoscopic surgery, and whether the lymph nodes were sampled.
  
  
  RESULTS
  Of 557 consecutive adult patients, 479 met our inclusion criteria. The overall, unadjusted 1- and 2-year local recurrences rate was 5.7% and 11.0%, respectively. From the adjusted analyses, an increased margin distance was significantly associated with a lower risk of local recurrence (P = .033). Patients with a 10-mm margin distance had a 45% lower local recurrence risk than those with a 5-mm distance (hazard ratio, 0.55; 95% confidence interval, 0.35-0.86). Beyond 15 mm, no evidence of additional benefit was associated with an increased margin distance.
  
  
  CONCLUSIONS
  In wedge resection for small non-small cell lung cancer, increasing the margin distance ≤15 mm significantly decreased the local recurrence risk, with no evidence of additional benefit beyond 15 mm.
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Kamran
authors: K
authors: Mohiuddin
authors: Department of Biostatistics, Harvard School of Public Health, Boston, Mass.
authors: Sebastien
authors: S
authors: Haneuse
authors: Department of Biostatistics, Harvard School of Public Health, Boston, Mass.
authors: Tamar
authors: T
authors: Sofer
authors: Department of Radiology, Brigham and Women's Hospital, Boston, Mass.
authors: Ritu
authors: R
authors: Gill
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Michael T
authors: MT
authors: Jaklitsch
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Yolonda L
authors: YL
authors: Colson
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Jon
authors: J
authors: Wee
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Raphael
authors: R
authors: Bueno
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Steven J
authors: SJ
authors: Mentzer
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: David J
authors: DJ
authors: Sugarbaker
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: sjswanson@partners.org.
authors: Scott J
authors: SJ
authors: Swanson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies