title: Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer.
abstract: BACKGROUND
  Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques.
  
  
  METHODS
  Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1).
  
  
  RESULTS
  The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups. The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV1ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV1ratios, respectively).
  
  
  CONCLUSIONS
  A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing large-scale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Terumoto
authors.initials: T
authors.lastname: Koike
authors.affiliation: Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Koike
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Seijiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Takehisa
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Katsuo
authors.initials: K
authors.lastname: Yoshiya
authors.affiliation: Department of Thoracic Surgery, Japanese Red Cross Nagaoka Hospital, Nagaoka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamato
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Akazawa
authors.affiliation: Niigata University Crisis Management Office, Niigata University, Niigata, Japan.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Toyabe
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsuchida
keywords: Lung cancer surgery; lobectomy; lung cancer clinical trials; segmentectomy; wedge resection