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OBJECTIVE: Planned segmentectomy in cT1a lung cancer patients can be converted to lobectomy intraoperatively by various factors. We investigated the pattern and indication of conversion to lobecotmy from planned segementectomy in cT1a lung cancer.
METHODS: Data of 43 patients with cT1a lung cancer and was indicated for thoracoscopic segmentectomy from 2011 to 2013 were retrospectively reviewed. Indication of thoracoscopic segmentectomy was clinical Ia lung cancer with tumor size 2 cm or less. Patients who underwent segmentectomy due to pulmonary dysfunction were excluded.
RESULTS: Thirty-nine patients had no preoperative histologic diagnosis. Radiologic nodule characteristics were pure GGN in 22 (51%), part-solid nodule in 13 (30%) and solid nodule in 8 (19%). Histology were adenocarcinoma in 22, adenocarcinoma in situ (AIS) in 19 and other in 2. Mean tumor size was 1.1±0.4mm radiologically and 1.2±0.6mm pathologically. pathologic T stage was T1b in 1 due to tumor size and T2a in 3 due to tumor size or visceral pleura invasion. One lobectomy patient had lymph node metastasis at N1 and N2 nodes. Pathologic stage were Ia in 39, Ib in 3 and IIIa in 1. Segmentectomy was completed in 16 (37.2%) patients. Wedge resection with curative intent was performed in 4 (9%) because frozen examination result was AIS. Lobectomy was performed in 23 (53%) patients. The most common indication for conversion to lobectomy was invasive adenocarcinoma by frozen examination in 12 (52%). Close resection margin by intraoperative assessment was indication in 7 (30%) patients. One patient had both indication factors. Small volume of residual lung parenchyma after segmentectomy was indication in 3 (13%) patients. Lobectomy was performed in 2 Ib and 1 IIIa patients. One stage Ib patient underwent segmentectomy eventually. Radiologic tumor size of this patient was 1cm. There was no conversion to thoracotomy.
CONCLUSIONS: Althouh segmentectomy is indicated in cT1N0M0 lung cancer, conversion to lobectomy is necessary in some patients based on pathologic finding of frozen examination, intraoperative assessment of resection margin and volume of residual lung parenchyma to avoid compromised oncologic surgery. Thoracic surgeons should be prepared for conversion of planned segmentectomy to lobectomy intraoperatively based on these findings.