Importance of microscopic residual disease at the bronchial margin after resection for non-small-cell carcinoma of the lung

Liewald, F.; Hatz, Rudolf; Dienemann, Hendrik; Sunder‐Plassmann, L.

doi:10.1016/s0022-5223(19)34796-8

Cited by 42 publications

(26 citation statements)

References 10 publications

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“…3 Although more radical resections are often associated with a higher perioperative morbidity and mortality, previous studies have demonstrated improved long-term survival associated with re-resection for positive margins following lobectomy for stage I or II NSCLC. 4,11,12 Unfortunately, these data are limited to small single-center reviews. For example, Snijder et al 6 reviewed 28 patients who were found to have microscopic residual disease, five of which underwent re-resection.…”

Section: Discussionmentioning

confidence: 99%

Survival after radiation for stage I and II non-small cell lung cancer with positive margins

Gulack

Cox

Yang

et al. 2018

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 99%

Survival after radiation for stage I and II non-small cell lung cancer with positive margins

Gulack

Cox

Yang

et al. 2018

Journal of Surgical Research

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“…A resection that is either grossly or microscopically incomplete (R1 or R2 resection) is essentially akin to having performed no resection at all. 12,13 A potential exception to this is the patient who has residual microscopic disease confined to the mucosa of the bronchial stump with no extramucosal or peribronchial tumor. Such patients may be cured with postoperative radiation.…”

Section: Results Of Surgical Resection Alone For Stages I-ii Nsclcmentioning

confidence: 99%

Evidence-Based Outcomes for Patients with Non-Small Cell Lung Cancer Undergoing Resection

Rusch

2000

Seminars in Respiratory and Critical Care Medicine

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Surgery plays a vital role in the management of Stages I-IIIa NSCLC. Careful patient selection and improved perioperative care now allow pulmonary resection to be performed with a very low morbidity and mortality even in older patients, or in patients undergoing pneumonectomy or extended operations. Most patients with Stage IIIb disease are not candidates for surgery, but resection can be curative for highly selected groups of patients with T4 tumors when these are not associated with nodal metastases. Surgery in conjunction with induction chemotherapy or chemoradiation has become a standard approach to the management of Stage IIIa (N2) disease and, in that setting, can be performed safely and effectively. The role of surgical resection in the treatment of NSCLC will undoubtedly continue to evolve as we gain a better understanding of the biology and multimodality therapy of this disease.

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“…12,13 However, not all studies report a prognostic difference between R0 and R1 status. 10,16,17 Explanations for publications that do not find differences between R0 and R1 resections may be small numbers where trend is available, and failure to consider morphological subgroups. 17 Frozen section analysis is indicated if, in the preoperative work-up, the tumour is shown to be in close proximity to the bronchial resection margin or if the surgeon considers the resection margin at risk during the operation.…”

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“…N2 disease status (90 of 117 cases pooled from five references). 6,8,12,13,17 In another study, lymphangitic spread was specifically recorded and was shown to have independent prognostic value. 5 In R1 cases with peribronchial spread the prognosis is similar to those with stage III disease as recurrence in the form of distant metastases is frequently seen.…”

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confidence: 99%

“…16 Initially, fragmentary data on a small number of cases (range 8-36) reported false-negative rates for bronchial margin frozen section analysis of 42-60%. 8,12,17 This might be due not only to the interpretation, but also to the representiveness of the frozen section sample: 'frozen sections failed to show tumour at resection margin'. 12 It is essential to realize that in routine paraffin-embedded sections, a more distal part of the bronchus is examined compared with the frozen section, which is prepared from the proximal bronchial fragments dissected off before the remainder of the specimen is fixed in formalin and embedded in paraffin with the proximal side positioned face-up in the block.…”

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Implications of frozen section analyses from bronchial resection margins in NSCLC

Thunnissen

Bakker

2005

Histopathology

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Radical surgical resection offers the best chance of survival for up to stage III non-small cell lung cancer (NSCLC). In lung cancer, frozen section analysis of bronchial resection margins is performed with the option of extending the surgical resection to maximize the chance of local control and thereby cure. The outcome of the frozen section analyses has thus far been categorized as: 'resection margins free' (no residual tumour ¼ R0) or 'resection margins tumour positive'. The presence of residual tumour in the final resection margin is further divided into R1 for microscopic and R2 for macroscopic residual tumour. 1 In older studies incomplete resection margins are described in 4.1-14.7% of pulmonary resections. [2][3][4] Incomplete resection was associated with an unfavourable prognosis due to local recurrence. Since intraoperative macroscopic examination does not always detect the presence of residual tumour, frozen section analysis has been advocated for bronchial resection margins. In more recent literature the frequency of incomplete bronchial resection margins lies between 1.2 and 5.4% (mean 3.6%). 5-11 The type of surgery does not seem to correlate to the risk of R1 resection status, except possibly for sleeve resection. [12][13][14][15] Follow-up information reveals that a tumour-positive resection margin is an adverse prognostic factor in many studies. 1-3,5-8,13 A critical methodological note may be that only part of these studies report information on the control arm. 1,6,7,9 In case of an R1 resection and the absence of lymph node metastases (N0 disease), recurrences are more frequently local than at distant sites, whereas in cases with mediastinal lymph node metastases (N2 disease) the opposite is the case. 12,13 However, not all studies report a prognostic difference between R0 and R1 status. 10,16,17 Explanations for publications that do not find differences between R0 and R1 resections may be small numbers where trend is available, and failure to consider morphological subgroups. 17 Frozen section analysis is indicated if, in the preoperative work-up, the tumour is shown to be in close proximity to the bronchial resection margin or if the surgeon considers the resection margin at risk during the operation. In sleeve resections this is practically always the case. For a distance of 15 mm it was estimated that 93% of all non-small cell carcinomas would have a free resection margin. 18 Therefore, it is reasonable to suggest that frozen section analysis should be restricted to those cases in which the preoperative evaluation has shown that the distance of tumour to the supposed bronchial resection margin is 20 mm or less. 18,19 Only an exceptional case will then turn out to have a positive resection margin. 2,18 Remarkably, preoperative data from X-ray, computed tomographic scan analysis or bronchoscopy on this subject are lacking.In several studies a distinction is made in the anatomical localization of tumour tissue in the bronchial resection margins of non-small cell carcinoma. However, the empl...

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Importance of microscopic residual disease at the bronchial margin after resection for non-small-cell carcinoma of the lung

Cited by 42 publications

References 10 publications

Survival after radiation for stage I and II non-small cell lung cancer with positive margins

Survival after radiation for stage I and II non-small cell lung cancer with positive margins

Evidence-Based Outcomes for Patients with Non-Small Cell Lung Cancer Undergoing Resection

Implications of frozen section analyses from bronchial resection margins in NSCLC

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