Sublobar resection without staging and lymphadenectomy for ≤2 cm Non-Small Cell Lung Cancer is no adequate therapy

Elsevier

Available online 29 August 2022, 101840

Surgical OncologyHighlights•

Sublobar resection is a frequently performed for NSCLC patients with <2cm nodules.

The majority of studies dealing with sublobar resection do not perform guideline-based staging containing PET-CT and cMRI. Furthermore, little to no lymphadenectomy is performed intraoperatively.

Of our patients with <2cm NSCLC 16.5% were nodal upstaged postoperatively although we performed guideline staging in all patients and EBUS was very frequently preformed.

Of the nodal upstaged patients 16.1% showed Lymphangiosis carcinomatosa (L1) and 7.5% of patients showed L1 without simultaneous lymph node affection.

Preoperative staging and surgical management of NSCLC <2 cm should always follow current guidelines. Staging should include CT Thorax, PET CT, cMRI in all cases.

AbstractObjective

Sublobar resection is frequently performed for Non-Small Cell Lung Cancer (NSCLC) patients with ≤2cm nodules. Frequently, both proper staging and radical lymphadenectomy are omitted in these operations. Therefore, we decided to evaluate the number of lymph node metastases and the number of postoperative nodal upstaging in patients undergoing pulmonary resection due to NSCLC with tumors ≤2cm at our institution.

Methods

Nodal upstaging, lymphangiosis- (L1), and hemangiosis carcinomatosa (V1) were analyzed. pN0 patients were compared to patients with postoperative nodal upstaging. One-, three, and five-year survival rates were measured. Survival was also assessed by the Kaplan-Meier method.

Results

747 patients underwent surgery for NSCLC at our institution between 2012 and 2020. We retrospectively reviewed data of 236 NSCLC patients with ≤2cm tumors. The mean tumor size was 1.4cm ± 0.39 in our cohort. Of our patients, 14% showed a cT1a tumor, and 86% of patients cT1b. 24.0 ± 12.3 lymph nodes were dissected and analyzed per patient, and 0.7 ± 2.0 of those were affected. Of our patients, 16.1% showed L1 affection, and 7.6% a V1 affection. Lymph node involvement was diagnosed in 11(4.7%) patients preoperatively. 39(16.5%) patients were upstaged due to lymph node involvement postoperatively (p < 0.001). Upstaged patients showed significantly worse 3- (upstaged: 60.6% vs. pN0: 83.2%; p = 0.01) and 5-year (upstages: 38% vs. pN0 71.5%; p = 0.02) survival rates.

Conclusion

16.5% of patients with ≤2cm NSCLC were nodal upstaged postoperatively. These results underline that lymphadenectomy and proper staging are crucial for NSCLC patients irrespective of the tumor size and the surgical approach.

Keywords

NSCLC

Nodal upstaging

Sublobar resection

Lymphangiosis carcinomatosa

Hemangiosis carcinomatosa

Lymph node metastases

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