title: Sublobar resection for lung adenocarcinoma meeting node-negative criteria on preoperative imaging.
abstract: BACKGROUND
  This study evaluated the usefulness of sublobar resection for patients with clinical stage IA lung adenocarcinoma that met our proposed node-negative criteria: solid tumor size of less than 0.8 cm on high-resolution computed tomography or maximum standardized uptake value of less than 1.5 on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography.
  
  
  METHODS
  A multicenter database of 618 patients with completely resected clinical stage IA lung adenocarcinoma who underwent preoperative high-resolution computed tomography and [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography was used to evaluate the surgical results of sublobar resection for patients who met our node-negative criteria.
  
  
  RESULTS
  No patient who met the node-negative criteria had any pathological lymph node metastasis. Recurrence-free survival (RFS) and overall survival (OS) rates at 5 years were significantly higher for patients who met the node-negative criteria (RFS: 96.6%; OS: 95.9%) than for patients who did not (RFS: 75.5%, p<0.0001; OS: 83.1%, p<0.0001). Among patients who met the node-negative criteria, RFS and OS rates at 5 years were not significantly different between those who underwent lobectomy (RFS: 96.0%; OS: 95.9%) and those who underwent sublobar resection (RFS: 97.2%, p=0.94; OS: 95.9%, p=0.98). Of 264 patients with T1b (2-cm to 3-cm) tumors, 106 (40.2%) met the node-negative criteria.
  
  
  CONCLUSIONS
  Sublobar resection without systematic nodal dissection is feasible for clinical stage IA lung adenocarcinoma that meets the above-mentioned node-negative criteria. Even a T1b tumor, which is generally unsuitable for intentional sublobar resection, can be a candidate for sublobar resection if it meets these node-negative criteria.
authors.affiliation: Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tsutani
authors.affiliation: Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyata
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Okumura
authors.affiliation: Department of Radiology, Hyogo Cancer Center, Akashi, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Adachi
authors.affiliation: Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. Electronic address: morihito@hiroshima-u.ac.jp.
authors.forename: Morihito
authors.initials: M
authors.lastname: Okada
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D049268:Positron-Emission Tomography / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18