Lung Adenocarcinoma
Conditions
Keywords
frozen sections, lobectomy, segmentectomy, micropapillary
Brief summary
This study aims to evaluate the superiority in recurrence-free survival of lobectomy compared with segmentectomy in patients with lung adenocarcinoma ≤ 2 cm with micropapillary and solid subtype positive by intraoperative frozen sections.
Detailed description
At present, the technology of intraoperative frozen section has gradually matured, which can diagnose the benign and malignant tumors and guide the resection strategy for peripheral small-sized lung adenocarcinoma. Travis et al. reported high specificity of intraoperative frozen section in the identification of micropapillary components, confirming that intraoperative frozen section may guide the selection of surgical procedures. However, there is still little evidence whether segmentectomy is appropriate for invasive adenocarcinoma without micropapillary patterns. This prospective and multi-center study was aimed to evaluate the superiority in recurrence free survival and overall survival of lobectomy compared with segmentectomy in patients with lung adenocarcinoma (≤ 2 cm) containing positive micropapillary components.
Interventions
PROCEDURELobectomy with systemic lymph node dissection
Lobectomy with hilar and mediastinal lymph node dissection is performed. Segmentectomy with hilar and mediastinal lymph node dissection is performed. Systemic or selective lymph node dissection is mandatory, and nodal sampling is not allowed. At least three stations of mediastinal lymph node from 2R, 4R, 7, 8, 9 for the right side and 5, 6, 7, 8, 9 for the left side, respectively. The distance from the dissection margin to the tumor edge must be evaluated intra-operatively. If the distance is either less than the maximum tumor diameter or 20 mm, the absence of cancer cells in the resection margin must be histologically or cytologically confirmed before finishing surgery.
PROCEDURESegmentectomy with systemic lymph node dissection
Segmentectomy with hilar and mediastinal lymph node dissection is performed. If the tumor located at inter-segment plane and without sufficient resection margin distance, a combined segmentectomy will be performed. Systemic or selective lymph node dissection is mandatory, and nodal sampling is not allowed. At least three stations of mediastinal lymph node from 2R, 4R, 7, 8, 9 for the right side and 5, 6, 7, 8, 9 for the left side, respectively. The distance from the dissection margin to the tumor edge must be evaluated intra-operatively. If the distance is either less than the maximum tumor diameter or 20 mm, the absence of cancer cells in the resection margin must be histologically or cytologically confirmed before finishing surgery.
Sponsors
Shanghai Pulmonary Hospital, Shanghai, China
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to 79 Years
Healthy volunteers
Yes
Inclusion criteria
* Tumor size ≤ 2 cm; * Solitary tumor and located in the outer third of the lung field; * Preoperative CT indicated that the nodules were single nodules or Concomitant nodules was less than minimal invasive adenocarcinoma; * Intraoperative frozen section confirmed invasive lung adenocarcinoma and with micropapillary and solid patterns positive (\>5%); * Confirmation of R0 status by intraoperative frozen section analysis; * Pulmonary function could withstand both segmentectomy and lobectomy (FEV1 \> 1.5 L or FEV1% ≥ 60%); * Sufficient organ function; * Performance status of 0,1 or 2； * Written informed consent.
Exclusion criteria
* The tumor is close to the hilum, which cannot perform segmentectomy ; * Patients suspected of lymph node positive by preoperative examination, including CT scans and mediastinal lymph node biopsy; * Evidence revealed locally advanced or metastatic disease; * Intraoperative exploration revealed accidental pleural dissemination. * Patients with severe damage to heart, liver and kidney function (grade 3 \ 4, Alanine aminotransferase (ALT) and/or Aspartate aminotransferase (AST) over 3 times the normal upper limit, Cr over the normal upper limit). * Patients concomitant with other malignant tumors； * Patients had prior chemotherapy, radiotherapy or molecular targeted therapy for this malignancy. * History of severe heart disease, heart failure, myocardial infarction within the past 6 months. * The patients who were not suitable for inclusion by researchers' evaluation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| recurrence-free survival rate | 5 year | Recurrence-free survival (RFS) was defined as the time from surgery until recurrence or death from any cause |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| overall survival rate | 5 year | Overall survival (OS) was defined as the time from surgery until death from any cause |
Countries
China
Contacts
Primary ContactLong Xu, MD
Outcome results
None listed