BACKGROUND. The significance of limited resections, including wedge resecti
on and segmentectomy, remains controversial because of their curability rat
es. In the current study, the objective was to determine a strategy for the
treatment of patients with roentgenographically occult bronchogenic squamo
us cell carcinoma (ROSCC) based on the pathologic findings from 184 patient
s with ROSCC who underwent resection.
METHODS. In Miyagi Prefecture, 1422 patients with lung carcinoma were diagn
osed during a mass screening program between 1982 and 1995. Among them, 236
patients had ROSCC, and 184 patients with ROSCC underwent pulmonary resect
ion followed by systemic lymph node dissection.
RESULTS. Pathologically, only 0.9% of the ROSCCs that were within the range
of endoscopic visibility were revealed to have lymph node involvement, whe
reas 13% of patients with extracartilage invasion had lymph node involvemen
t. Early ROSCC, which means ROSCC that is limited within the cartilaginous
layer and is without lymph node involvement, comprised 90% of ROSCCs that m
easured <10 mm in longitudinal extension, comprised 77% of ROSCCs that meas
ured 10-29 mm in longitudinal extension, and comprised 33% of ROSCCs that m
easured >30 mm in longitudinal extension. Eighty-nine percent of the tumors
with lymph node involvement had extracartilaginous invasion. The 3-year su
rvival rate of patients after undergoing photodynamic therapy was 100% when
their tumor was regarded as early ROSCC (i.e., within 10 mm in longitudina
l extension and within the range of endoscopic visibility). To date, 18 pat
ients with ROSCC underwent segmentectomy, and all of these patients are ali
ve without tumor recurrence. The incidence rate of multiple lung carcinomas
, including synchronous and metachronous tumors, in patients with ROSCC was
22%.
CONCLUSIONS. The authors concluded the following: 1) Patients with lesions
that are within the range of endoscopic visibility and that measure <10 mm
in longitudinal extension are candidates for photodynamic therapy. 2) Patie
nts with lesions that are beyond the range of endoscopic visibility or that
measure >10 mm in longitudinal extension are candidates for segmentectomy
as long as intraoperative examination shows a tumor free bronchial stump an
d negative lymph nodes 11-13. 3) Patients with lesions that show bronchial
obstruction or extrabronchial invasion should undergo standard resection. C
ancer 2000;89:2445-8. (C) 2000 American Cancer Society.