EP1.17-16 Ultra-Small Lung Cancer (≤0.5cm) Is Facing Dilemma Situation of Over-Resection

Abstract

Lung cancer is increasing rapidly in China. More and more ground-glass opacity (GGO) nodules, micro-small pulmonary nodules (micro-SPN, ≤1.0cm), and ultra-small pulmonary nodules (ultra-SPN, ≤0.5cm) are being detected, most are not malignant, some are atypical adenomatous hyperplasia (AAH), but some are indeed early stage lung cancer, either adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA). Limited resection is reasonable for these micro-small lung cancer (micro-SLC, ≤1.0cm), and ultra-small lung cancer (ultra-SLC, ≤0.5cm), but we always face the dilemma situation that the patients prefer to ask for lobectomy instead of limited resection, no matter what the postoperative pathology will be, a MIA, AIS or just an AAH. For some patients, especially those with family cancer history suffer more mental pressure than others. On the other hand, we face the dilemma situation that when surgery performed at early stage, ultra-SPN stage, the result will be ultra-SLC, AIS, or AAH; when follow-up finds GGO nodules growing up, emerging with malignant signs, it will enter into micro-SPN stage, we may need to cut more lung tissues, the result will become micro-SLC, MIA; when enter into SPN (≤2.0cm) stage, it may become SLC (≤2.0cm), invasive lung adenocarcinomas (ILA). Video-assisted thoracoscopic surgery (VATS) and minimally invasive small incision, muscle- and rib-sparing thoracotomy (miMRST) were performed. Case 1: male, aged 60 in 2015, a peripheral ultra-SPN, GGO nodule, 0.3X0.3cm in right upper lobe; it became 0.5X0.3cm in Jan 2018, VATS wedge resection was performed. Case 2: female, aged 59 in 2013, an ultra-SPN, GGO nodules, 0.5X0.3cm in right middle lobe; the patient omitted it until it became 0.8X0.6cm in Nov 2016, VATS wedge resection was performed. Case 3: male, aged 55 in 2016, an ultra-SPN, GGO nodules, 0.5X0.4cm in lingular segment, segmentomy was advised; the patient refused; it became 1.0X0.8cm in Jan 2019, lingular segmentomy with lymph node sampling was advised, but the patient insisted on asking for lobectomy, instead of limited resection (both his brothers suffered from lung cancer). miMRST was performed for case 3. The patients recovered quickly from mini-invasive surgery. The final pathology was AIS, or MIA. Case 1: the frozen pathology was AAH; the postoperative pathology was AIS. Case 2: the frozen pathology was AAH; the postoperative pathology was MIA. Case 3: the frozen pathology was AAH; the postoperative pathology was MIA. No adjuvant treatment needed. Follow-up shows no recurrence and metastasis. Certain GGO nodules progress rapidly, surgery should be performed at much earlier stage, ultra-SPN stage, ultra-SLC stage might be of first choice. For Case 1: if the surgery was done earlier, the final result might be AAH, instead of AIS. For Case 2, 3: if the surgery was done earlier, especially at ultra-SPN stage, the postoperative pathology should be AAH, AIS, instead of MIA. To perform surgery at much earlier stage could help save much more lung tissues, to achieve a much better prognosis for micro-SLC and ultra-SLC patients. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05, 17-230-9-71 ).