Clinical Upstaging of Non-Small Cell Lung Cancer That Extends Across the Fissure: Implications for Non-Small Cell Lung Cancer Staging

Background. Little data exist as to the long-term outcome of non-small cell lung cancer that extends across the fissure into the adjacent lobe that requires either a bilobectomy or a lobectomy and wedge resection. Methods. Lobectomy survival data was benchmarked with the International Association for the Study of Lung Cancer (IALSC) dataset. Matched analysis of a prospective thoracic surgery database of 1,020 patients who had undergone lobectomy during a 6-year period was analyzed to elucidate the effect on long-term survival of tumors that extend across the interlobar fissure. Results. Benchmarking revealed our data are not significantly different from the IALSC dataset, allowing survival recommendations to be drawn. Histopathologic staging of matched patients was IA, 11.7%; IB, 51.1%; IIA, 1.7%; IIB, 21.1%; IIIA, 10.0%; IIIB, 2.8%; and IV, 1.7%. Stage I tumors crossing the interlobar fissure had a reduction in survival that is significant (10% to 15%) after 5 years (p = 0.037). The 5-year survival for stage I tumors extending across a lung fissure was 50%. This places the 5-year survival between stage I and II (60% and 40%, respectively). There was no difference in survival for tumors stage IIA and above with regard to importance of interlobar extension. The number of patients was too small to detect a significant difference between bilobectomy versus lobectomy and wedge. Conclusions. Non-small cell lung cancer that extends across the fissure into an adjacent lobe requiring a bilobectomy or a lobectomy and wedge resection has a 5-year survival between stages I and II. (Ann Thorac Surg 2011; 91: 350-4) (C) 2011 by The Society of Thoracic Surgeons