Prognostic factors and clinical outcome in patients with surgically resected peripheral N0 adenocarcinoma <3 cm

BACKGROUND: Many reports emphasize the role of sub-lobar resections in the treatment of small peripheral lung cancer. The aim of this study was to investigate a range of prognostic factors, including the extension of resection, which may affect the prognosis in a homogeneous group of patients. METHODS: We retrospectively reviewed the clinical records of 279 patients affected by N0 small peripheral adenocarcinoma (ADK) &lt;3 cm that underwent surgery between 2000 and 2010. Eleven patients were excluded due to non-tumour-related death. RESULTS: There were 176 (66%) males and 92 (34%) females with a median age of 74 years (range 47-93). In the series, 229 (85%) patients received a lobar resection and only 39 (15%) a sub-lobar resection. One hundred ninety-five patients (72%) resulted stage IA while 73 (28%) stage IB. No differences in 5-year survival were observed according to: age (P=0.32), sex (P=0.42), T1a vs. T1b (P=0.31), stage IA vs. IB (P=0.51) and type of resection (P=0.29). Patients affected by ADK with a predominant lepidic growth showed a better 5-year survival (91.3% vs. 81.5%; P=0.044). The multivariate analysis confirmed the growth pattern as an independent risk factor (P=0.048). In patients with visceral pleura infiltration, the sub-lobar resection was associated with a significantly lower 5-year survival compared to lobectomy (63% vs. 90%; P=0.033). The visceral pleural infiltration was independent from ADK growth pattern, predominant lepidic vs. non-lepidic (P=0.51), but it was significantly more frequent in the ADK&gt;2 cm (P=0.012). CONCLUSIONS: Small peripheral (&lt;3 cm) N0 lung ADK can be easily resected by wedge or anatomical segmentectomy. The lepidic growth pattern is the main prognostic factor independently from the extension of resection however, in case of visceral pleural involvement, lobectomy reduces significantly the risk of recurrence.