Intentional limited pulmonary resection versus lobectomy for treatment of peripheral stage IA non-small cell lung cancers

Background. The purpose of this study is to assess, through the retrospective analysis of our experience and the literature review, whether the limited pulmonary resection is comparable to lobectomy for treatment of the peripheral stage IA (T1N0M0) non-small cell lung cancers (NSCLC), in terms of oncologic radicality, survival and rate of local, regional and systemic recurrences. Moreover it has been considered the impact of the limited resections in comparison with the lobar resections on the postoperative pulmonary function. Patients and methods. We have analyzed a consecutive series of 36 patients, 28 men and 8 women, of inclusive age among the 61 to 81 years (average 73 years), who underwent surgical resection from January 2000 to December 2003 for T1N0M0 peripheral NSCLC; 11 limited resections and 25 lobectomies have been performed. Comparatively survival and recurrences (follow-up period of 3-5 years) are been analyzed, as well as the pulmonary function tests at 1 year after surgery. Results. The 3-year and 5-year survivals were 88% and 82% in the patient's group underwent to limited resection, 93% and 88% in the patient's group underwent to lobectomy. Postoperative local recurrence was noted in 1 patient (9%) of the first group and in 1 patient (4%) of the second group. One year after surgery was noted a moderate decline in the forced expiratory volume in 1 second (FEV1) and in the diffusing capacity for carbon monoxide (DLCO) in the patients who underwent to lobar resection, whereas in the patient's group submitted to limited resection was observed a substantial maintenance, except for the DLCO, of the preoperative pulmonary function tests. Conclusions. Our limited experience, according to the actual tendencies of the literature, show that the limited pulmonary resections, in selected patients with peripheral stage IA NSCLC, represents a valid alternative to lobectomy in terms of survival and recurrence's rate, also determining a lower decrement of the postoperative pulmonary function. Therefore the segmentectomy can be considered, in such cases, the gold-standard procedure even if the patient is able to bear a wider resection.