• Yasuhiro Tsutani, Yoshihiro Miyata, Haruhiko Nakayama, Sakae Okumura, Shuji Adachi, Masahiro Yoshimura, and Morihito Okada.
• Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
• Ann. Thorac. Surg. 2014 May 1;97(5):1701-7.

BackgroundThis 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.MethodsA 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.ResultsNo 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.ConclusionsSublobar 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.Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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