Ongoing prospective study of segmentectomy for small lung tumors

Background. Lesser resection for small lung tumors remains an unresolved pr oblem. This study was conducted to see whether this type of operation is ac ceptable or not. Methods. From 1992 to 1994, 55 patients were enrolled in a multicenter tria l of limited surgical resection for peripheral tumors of less than 2 cm dia meter. The procedure consisted of segmentectomy with exploration of lymph n odes by examining frozen sections. The operation was modified if the report was positive. The intersegmental plane was identified by keeping the resec ted segments inflated and the preserved segments collapsed. To divide the p lane, stapling or electrocauterization on the edge of the collapsed area wa s used. In this way the resection line was delivered beyond the burdened se gment; this was called extended segmentectomy. Results. There were no perioperative deaths, but there were eight postopera tive deaths. In 1 patient who died because of local recurrence, it had been known that the margin to the lesion had been narrow (15 mm); 1 had bilater al intrapulmonary nodules, 1 had nodules in the side that was not operated on, and another succumbed to a second neoplasm of small cell lung cancer 4 years after the first operation. The remaining 4 died of nonpulmonary disea ses. Almost all other patients are alive and free from recurrence, except f or 1 in whom N2 disease was not detected intraoperatively but was confirmed after the operation. Conclusions. The interim results suggest that extended segmentectomy is app licable in patients with a small peripheral lung cancer. However, a wide ma rgin and aggressive intraoperative pathologic examinations are mandatory. ( C) 1998 by The Society of Thoracic Surgeons.