Surgical management of early stage central (hilar) and peripheral nonsmallcell lung carcinoma

BACKGROUND. To the authors' knowledge, the definitions of early lung carcin oma used in Japan are not yet approved internationally In the current study the diagnostic methods, pathology, and results of the surgical treatment o f early hilar and peripheral nonsmall cell lung carcinoma cases defined by Japanese criteria are presented. METHODS. Between 1977 and 1998, 43 patients with early hilar lung carcinoma were encountered. These patients constituted 14.5% of 200 hilar lung carci noma patients who underwent resection during the same period. Between 1973 and 1998, there were 174 early peripheral lung carcinomas, which comprised 14.8% of 1173 peripheral lung carcinoma patients who underwent resection du ring the same period. RESULTS. The 5-year and 10-year survival rates of the early hilar lung carc inoma were 100% and 96.9%, respectively. The majority of the patients under went bronchoplastic surgery, such as sleeve lobectomy and parenchymal-spari ng surgery including seven sleeve segmentectomies and two second carinal re sections. The effectiveness of the parenchymal-sparing resections was asses sed by the conventional pulmonary function test as well as perfusion and ve ntilation scanning. There were 174 cases of peripheral early lung carcinoma among the 218 cases of peripheral lung carcinoma with tumor dimensions of less than or equal to 2 cm. The cell, types were 142 (81.6%) cases of adeno carcinoma, 18 (10.3%) cases of squamous cell carcinoma, and 14 (8%) cases o f other cell types. These 174 patients comprised 14.8% of 1173 patients wit h peripheral nonsmall cell lung carcinoma who underwent surgery during the same period. The 5-year and 10-year survival rates for adenocarcinoma were 89.6% and 86.8%, respectively. The 5-year and 10-year survival rates for ot her cell types were both 71.8%. The overall 5-year and 10-year survival rat es were 86.8% and 84.6%, respectively. CONCLUSIONS. Early lung carcinoma in both the hilar and peripheral regions, is curable if it is properly diagnosed and treated. Cancer 2000;89:2438-44 . (C) 2000 American Cancer Society.