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M. A solitary bronchial squamous cell papilloma with increased 18-fluorodeoxyglucose uptake and high serum levels of squamous cell carcinoma antigen.

available to guide best adjuvant treatments. Our objective was to determine the rate of positive parenchymal margins after non-pneumonectomy lung resection with an assessment of adjuvant treatment strategies and outcomes. Method: Ethics board approval was obtained for a retrospective analysis of prospectively collected data on all lung resections performed at the Ottawa Hospital during the period 2008-2014. Individual patient records were then examined to confirm margin status by a review of the final pathology report. Survival and disease-free intervals were analyzed using log-rank statistics, with significance set at 5%. Result: Over the study period, 1428 patients underwent non-pneumonectomy lung resection. A total of 29 cases (2%) were identified with a positive lung parenchymal margin (PPM). A matched subset (n¼662) of the remaining 1379 patients with negative parenchymal (NPM) were used as control group. Median followup for NPM was 36.7 [0-105.6] and for PPM was 29.1 [0.5-71.5]. Overall, lobectomy was the most common pulmonary resection performed; wedge resections represented the majority of the PPM (n¼16, 55%) followed by lobectomy (n¼9; 31%) and segmental resections (n¼1; 3%). Overall survival (Fig) and disease-free survival (not shown) were significantly (p<0.0001) worse for the PPM (Hazard ratio 5.59, 95%CI [2.05-15.6]) with a median survival of 31.5 months; the control group had not reached median survival. Stage I and II NSCLC were predominant in both groups; however positive margins were more often associated with metastatic disease (24% in PPM; 0.9% in NPM). The majority of PPM went on to receive additional treatment (n¼17; 68%) consisting of adjuvant chemotherapy (n¼7; 28%), radiotherapy (n¼4; 16%), chemoradiotherapy (n¼5; 20%) and re-resection in one case. The remaining patients were observed. Recurrence was found at the staple line in 7 cases (24%); the remainder recurred at distant sites. Conclusion:The overall rate of PPM in this study is low (2%) as compared to reported rates of 5-15%. Wedge resection for metastases was associated with most cases of PPM; most patients received additional treatment and had distant sites of recurrence. Overall survival was significantly worse for PPM despite adjuvant therapy, which likely reflects the underlying disease.

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