Impact of preoperative pathological confirmation on surgical and postoperative outcomes of lung resection for early stage lung cancer

Introduction: The frequency of detection of peripheral pulmonary lesion (PPL) in suspected early lung cancer has been increasing, and whether preoperative pathological diagnosis (PPD) for small PPLs should always be established before their surgical resection can become a worrisome problem for physicians. The aim of the study was to clarify the impact of obtaining PPD on surgical and postoperative outcomes of lung resection for early stage lung cancer. Material and methods: This was a retrospective review of cases that underwent surgical resection for known or suspected primary lung cancer presenting pathological stage 0 or 1, enrolled from June 2006 to May 2016. The patients divided into two groups according to PPD group (n = 57) and non-PPD group (n = 157) were compared. The procedure, node dissection, operation time, amount of bleeding, postoperative complications, postoperative length of stay, and postoperative recurrences were analyzed. Results: Among the 214 patients, no significant differences in operation time (248.5 +/- 88.6 versus 257.6 +/- 89.0, min, mean +/- SD, p = 0.328), amount of bleeding (195.3 +/- 176.5 vs 188.1 +/- 236.1, ml, p = 0.460), postoperative complication (5.2% vs 4.5%, p = 0.728), postoperative length of stay (10.6 +/- 6.3 vs 10.4 +/- 5.3, days, p = 0.827), or postoperative recurrences (21.0% vs 17.2%, p = 0.550) were seen between PPD and non-PPD groups. Conclusion: Therefore, PPD had less impact on surgical and postoperative outcomes of pathological stage 0 or 1 lung cancer; direct surgical resection without non-surgical biopsy would be acceptable with careful selection of cases.