World Journal of Surgery

, Volume 42, Issue 5, pp 1449–1457 | Cite as

Margin Width of Resected Lepidic Lung Cancer Does Not Affect Recurrence After Sublobar Resection

  • Youngkyu Moon
  • Kyo Young Lee
  • Jae Kil Park
Original Scientific Report



A sufficient resection margin is required for the sublobar resection of lung cancers. However, the width of the resection margin may not be important in lepidic adenocarcinoma, because such tumors are non- or minimally invasive. The purpose of this study was to determine the effect of resection margin width on the outcome of patients with lepidic-dominant adenocarcinoma after sublobar resection.


This study included 133 patients with small (≤2 cm), clinical N0M0 lung cancer who underwent sublobar resection with curative intent. The patients were divided into 4 groups: Group A, lepidic tumor with margin/tumor ratio <1; Group B, lepidic tumor with margin/tumor ratio ≥1; Group C, non-lepidic tumor with margin/tumor ratio <1; Group D, non-lepidic tumor with margin/tumor ratio ≥1. The clinicopathological features and survival outcomes between Group A and B patients, and between Group C and D patients were compared.


The 5-year recurrence-free survival (RFS) rates of Group A and B patients were both 100%. The 5-year RFS rates of Group C and D patients were 49.9 and 97.1%, respectively (p = 0.009). By multivariate analysis, the margin/tumor ratio was a significant independent factor for recurrence in patients with non-lepidic tumors (hazard ratio = 0.157, 95% confidence interval 0.027–0.898; p = 0.037).


Tumor recurrence after sublobar resection is not associated with short resection margins in patients with lepidic tumors. However, a short resection margin is a significant risk factor for recurrence in patients with non-lepidic tumors.



This research was not supported by outside funds.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.


  1. 1.
    Ginsberg RJ, Rubinstein LV (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group Ann Thorac Surg 60:615–622 discussion 622–613 CrossRefGoogle Scholar
  2. 2.
    Yoshida J, Nagai K, Yokose T et al (2005) Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience. J Thorac Cardiovasc Surg 129:991–996CrossRefPubMedGoogle Scholar
  3. 3.
    Cho JH, Choi YS, Kim J et al (2015) Long-term outcomes of wedge resection for pulmonary ground-glass opacity nodules. Ann Thorac Surg 99:218–222CrossRefPubMedGoogle Scholar
  4. 4.
    Eguchi T, Kadota K, Park BJ et al (2014) The new IASLC-ATS-ERS lung adenocarcinoma classification: what the surgeon should know. Semin Thorac Cardiovasc Surg 26:210–222CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Okada M, Koike T, Higashiyama M et al (2006) Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg 132:769–775CrossRefPubMedGoogle Scholar
  6. 6.
    Koike T, Kitahara A, Sato S et al (2016) Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg 101:1354–1360CrossRefPubMedGoogle Scholar
  7. 7.
    Cao C, Chandrakumar D, Gupta S et al (2015) Could less be more?—a systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection. Lung Cancer 89:121–132CrossRefPubMedGoogle Scholar
  8. 8.
    Blasberg JD, Pass HI, Donington JS (2010) Sublobar resection: a movement from the Lung Cancer Study Group. J Thorac Oncol 5:1583–1593CrossRefPubMedGoogle Scholar
  9. 9.
    Nakamura K, Saji H, Nakajima R et al (2010) A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol 40:271–274CrossRefPubMedGoogle Scholar
  10. 10.
    Sawabata N, Ohta M, Matsumura A et al (2004) Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. Ann Thorac Surg 77:415–420CrossRefPubMedGoogle Scholar
  11. 11.
    Travis WD, Brambilla E, Noguchi M et al (2011) International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6:244–285CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Goldstein NS, Ferkowicz M, Kestin L et al (2003) Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens. Am J Clin Pathol 120:720–724CrossRefPubMedGoogle Scholar
  13. 13.
    Travis WD, Brambilla E, Nicholson AG et al (2015) The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol 10:1243–1260CrossRefPubMedGoogle Scholar
  14. 14.
    Taioli E, Yip R, Olkin I et al (2016) Survival after sublobar resection for early-stage lung cancer: methodological obstacles in comparing the efficacy to lobectomy. J Thorac Oncol 11:400–406CrossRefPubMedGoogle Scholar
  15. 15.
    Moon Y, Lee KY, Moon SW et al (2016) Sublobar resection margin width does not affect recurrence of clinical N0 non-small cell lung cancer presenting as GGO-predominant NODULE of 3 cm or less. World J Surg 41:472–479. doi: 10.1007/s00268-016-3743-3 CrossRefGoogle Scholar
  16. 16.
    Moon Y, Sung SW, Lee KY et al (2016) Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. J Thorac Dis 8:1561–1570CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wilshire CL, Louie BE, Manning KA et al (2015) Radiologic evaluation of small lepidic adenocarcinomas to guide decision making in surgical resection. Ann Thorac Surg 100:979–988CrossRefPubMedGoogle Scholar
  18. 18.
    Moon Y, Sung SW, Lee KY et al (2016) Clinicopathological characteristics and prognosis of non-lepidic invasive adenocarcinoma presenting as ground glass opacity nodule. J Thorac Dis 8:2562–2570CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Moon Y, Sung SW, Lee KY et al (2016) The importance of the lepidic component as a prognostic factor in stage I pulmonary adenocarcinoma. World J Surg Oncol 14:37CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Tremblay L, Deslauriers J (2013) What is the most practical, optimal, and cost effective method for performing follow-up after lung cancer surgery, and by whom should it be done? Thorac Surg Clin 23:429–436CrossRefPubMedGoogle Scholar
  21. 21.
    Kiankhooy A, Taylor MD, LaPar DJ et al (2014) Predictors of early recurrence for node-negative t1 to t2b non-small cell lung cancer. Ann Thorac Surg 98:1175–1183CrossRefPubMedGoogle Scholar
  22. 22.
    Moon Y, Kim KS, Lee KY et al (2016) Clinicopathologic factors associated with occult lymph node metastasis in patients with clinically diagnosed N0 lung adenocarcinoma. Ann Thorac Surg 101:1928–1935CrossRefPubMedGoogle Scholar
  23. 23.
    Hung JJ, Yeh YC, Jeng WJ et al (2014) Predictive value of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma in tumor recurrence and patient survival. J Clin Oncol 32:2357–2364CrossRefPubMedGoogle Scholar
  24. 24.
    Moon Y, Sung SW, Namkoong M et al (2016) The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor. J Thorac Dis 8:2617–2625CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Heineman DJ, Ten Berge MG, Daniels JM et al (2016) The quality of staging non-small cell lung cancer in the Netherlands: data from the Dutch lung surgery audit. Ann Thorac Surg 102:1622–1629CrossRefPubMedGoogle Scholar
  26. 26.
    Ye B, Cheng M, Li W et al (2014) Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma. Ann Thorac Surg 98:217–223CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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