J.Jpn. Surg. Soc.. 117(4): 278-282, 2016

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Feature topic

RADICAL SEGMENTECTOMY AND WEDGE RESECTION FOR GOOD-RISK PATIENTS WITH PERIPHERAL CT1AN0M0 LUNG CANCERRADICAL SEGMENTECTOMY AND WEDGE RESECTION FOR GOOD-RISK PATIENTS WITH PERIPHERAL CT1AN0M0 LUNG CANCER

Lobectomy has been and remains the standard surgical treatment for peripheral cT1aN0M0 lung cancer because of the conclusion of the randomized controlled trial performed by the Lung Cancer Study Group in 1995, and limited resection (segmentectomy and wedge resection) is still not the standard treatment for patients who are candidates for lobectomy; limited resection compared with lobectomy was statistically associated with a significantly greater incidence of local recurrence, although no statistically significant difference was identified in overall survival. In 2002, a Japanese prospective single-arm study of peripheral cT1aN0M0 lung cancer revealed no significantly different outcomes between segmentectomy and lobectomy with aggressive lymph node examination using frozen sections and wide surgical margins; the 5-year survival rate was 81.8％ and local recurrence rate was 1.8％. Recently, two clinical trials conducted by the Japan Clinical Oncology Group (JCOG) have completed patient enrollment: JCOG0802, a phase III randomized trial of lobectomy versus segmentectomy for small peripheral non-small cell lung cancer; and JCOG0804, a nonrandomized confirmatory study of limited surgical resection for peripheral early lung cancer as defined based on thoracic thin-section computed tomography. The results will be published in the near future, and the standard treatment for peripheral cT1aN0M0 lung cancer may change.

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