Long-term Outcome of Patients with Peripheral Ground Glass Opacity Dominant Lung Cancer After Sublobar Resections

In 2011, Makoto Suzuki, MD, and a team of associates from across Japan embarked on a long-term study of the safety and efficacy of sublobar resections for ground-glass opacity–dominant (GGO) peripheral lung cancer. When the group began the study, the optimal mode of surgery for GGO–dominant peripheral lung cancer defined with thoracic thin-section computed tomography was speculated as sublobar resection but not proven. At that time, the planned sample size was 330 with the expected 5-year relapse-free survival of 98% and a threshold of 95%.

Between May 2009 and April 2011, 333 patients were enrolled from 51 institutions in Japan (median age was 62 at registration) and followed until May 6, 2021. Among that group, sublobar resections were performed in 314 patients (258 wedge resections and 56 segmentectomies), conversion lobectomies were performed in 11 patients, and eight were ineligible.

At five years, the group concluded that sublobar resection with enough surgical margin offered sufficient local control and relapse-free survival for lung cancer clinically resectable N0 staged by thin-section computed tomography with 3 or fewer peripheral lesions 2.0 cm or less amenable to sublobar resection and with a consolidation tumor ratio of 0.25 or less.

At 10 years, the group can now report the reintervention-free survival of 98.6% and the overall survival of 98.5% for the 314 patients with sublobar resections. It concludes that the long-term results from their study suggest that sublobar resection for peripheral GGO-dominant lung cancer patients is a surgical procedure that can fully cure them of the disease. The indication of other treatment options should be further investigated.

Dr. Suzuki will present this study Sunday, May 7, at the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting in Los Angeles.