Sublobar resection for patients with peripheral small adenocarcinomas of the lung: Surgical outcome is associated with features on computed tomographic imaging

Background. Sublobar resection for peripheral small adenocarcinomas of the lung remains controversial. We studied the feasibility of deciding whether to perform limited pulmonary resection on the basis of preoperative images obtained by high-resolution computed tomography. Methods. A total of 123 patients with adenocarcinoma of the lung underwent sublobar resection of clinical T1N0M0 tumors measuring 2 cm or less in diameter on high-resolution computed tomography. Patients with multiple lung cancers or a history of lung cancer or other malignancies were excluded. The remaining 63 patients were studied. All tumors were classified as "air-containing type" or "solid-density type" according to the tumor shadow disappearance rate on high-resolution computed tomography. We evaluated the surgical outcomes of sublobar resection with respect to findings on high-resolution computed tomography images. Results. Forty-six patients had air-containing type tumors (tumor shadow disappearance rate >= 50%), and 17 had solid-density type tumors (tumor shadow disappearance rate <50%). Forty-nine wedge resections and 14 segmentectomies were performed. Wedge resection was the most common procedure in patients with air-containing type tumors. Pathologically, air-containing type tumors comprised 38 bronchioloalveolar carcinomas and 8 nonbronchioloalveolar carcinomas. No patient with air-containing type tumors had recurrence after a median follow-up of 70 months (range, 21 to 133 months). Overall and relapse-free survival rates at 5 years were 95% and 100%, respectively, in patients with air-containing type tumors, as compared with 69% and 57%, respectively, in those with solid-density type tumors. Conclusions. Sublobar resection might be an acceptable procedure for the treatment of small air-containing type adenocarcinomas of the lung on preoperative high-resolution computed tomography. However, our findings must be confirmed in larger, multicenter studies.