Margin and local recurrence after sublobar resection of non-small cell lung cancer

Background: Local recurrence is a major concern after sublobar resection (SR) of non-small cell lung cancer (NSCLC). We postulate that a large proportion of local recurrence is related to inadequate resection margins. This report analyzes local recurrence after SR of stage I NSCLC. Stratification based on distance of the tumor (< 1 cm vs >= 1 cm) to the staple line was performed. Methods: We reviewed 81 NSCLC patients (44 female) who underwent operation over an 89-month period (January 1997 to June 2004). Mean forced expiratory volume in one second percentiles (FEV1) was 57%. Mean age was 70 (46-86) years. There were 55 wedge and 26 segmental resections. There were 41 tumors with a margin < 1 cm and 40 with a margin >= 1 cm. Local recurrence was defined as recurrence within the ipsilateral lung or pulmonary hilum. Results: There were no perioperative deaths. Mean follow-up was 20 months. Margin distance significantly impacted local recurrence; 6 of 41 patients (14.6%) developed local recurrence in the group with margin less than 1 cm versus 3 of 40 patients (7.5%) in the group with margin equal to or more than 1 cm (P=.04). Of the 41 patients with margins < 1 cm, segmentectomy was used in 7 (17%), whereas in the 40 patients with the >= 1 cm margins, segmentectomy was used in 19 (47.5%). Conclusions: Margin is an important consideration after SR of NSCLC. Wedge resection is frequently associated with margins less than 1cm and a high risk for locoregional recurrence. Segmentectomy appears to be a better choice of SR when this is chosen as therapy.