Optimal Extent of Pulmonary Resection in Clinical Stage IA Non-Small Cell Lung Cancer

Prior treatment

• Bilobectomy, sleeve resection, pneumonectomy, concomitant wedge resection, or concomitant thoracic procedure (including cardiac surgery) is performed.

Other illness

• Histologic diagnosis other than NSCLC (such as small cell lung cancer, carcinoid, pulmonary lymphoma, or other benign lung disease, etc).
• M1a disease is confirmed intraoperatively or postoperatively.
• Synchronous or metachronous multiple cancers (within the past 5 years).
• Interstitial lung disease or severe pulmonary emphysema which makes it impossible to tolerate either lobectomy or sublobar resection.
• Active bacterial or fungal infection.
• Uncontrolled systemic disease which makes the patient medically unfit for thoracic surgery such as unstable angina, recent myocardial infarction, congestive heart failure, or end-stage renal or liver disease.
• Serious mental illness or psychosis.

Other

• Hilar or mediastinal lymph node metastasis suspected on imaging studies (CT or PET/CT) or confirmed preoperatively by EBUS or mediastinoscopy.
• Parietal pleura, chest wall, or mediastinal invasion is confirmed intraoperatively or postoperatively.

• The following features should be fulfilled at preoperative thin-section CT scans
  • Solitary lung nodule
  • Lesion size is 3cm or less in its maximal dimension of the entire tumor
  • The center of the tumor is located in the outer third of the lung field in either the transverse, coronal, or sagittal plane
  • Lung cancer is suspected (or NSCLC if tissue diagnosis already obtained)
• Clinical stage T1a-bN0M0 (according to 7th AJCC staging system)
• Absence of proximal segmental or lobar bronchial involvement.
• NSCLC must be confirmed in intraoperative frozen section biopsies or postoperative pathologic examinations if the lesion was not histologically confirmed before operation.
• Age ≥ 18 years and \< 75 years.
• ECOG performance status 0-1.
• The patient should have adequate cardiopulmonary reserve to tolerate lobectomy (ppo FEV1 \> 40% and ppo DLCO \> 40% or VO2 max \> 15ml kg-1 min-1)
• No prior chemotherapy or thoracic radiotherapy for any malignancy.
• No prior malignancy within 5 years from study entry (except for non-melanoma skin cancer, superficial bladder cancer, thyroid cancer or carcinoma in situ of the uterine cervix).
• The patient agrees to participate in the study and signs the informed consent form.