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Masao Naruke



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    P2.09 - Pathology (ID 174)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.09-26 - Inadequate Surgical Margins at Video-Assisted Thoracoscopic Wedge Resection of Ground-Glass Opacity Lung Adenocarcinoma (ID 2163)

      10:15 - 18:15  |  Presenting Author(s): Masao Naruke

      • Abstract
      • Slides

      Background

      Limited resection is now indicated for more patients with ground-glass opacity (GGO) lung cancer, supported by advances in histological analysis and prognostic assessment of this disease. This study involved pathological examination of the possibility of inadequate surgical margins at video-assisted thoracoscopic (VATS) wedge resection of GGO lung cancer.

      Method

      Among 12 patients with GGO lung cancer who underwent VATS wedge resection in a 4-year period (April 2012-March 2016), 4 (12%) had local recurrence detected by follow-up computed tomography (CT). Surgical margins determined intraoperatively in these 4 patients were reexamined pathologically. The median proportion of GGO component determined by preoperative CT was 78.75%. In principle, percutaneous CT-guided lung needle marking of the center of a lesion was performed immediately before surgery, and the lesion was excised with 1-cm margins from the collapsed lung under one-lung ventilation. VATS wedge resection was selected based on the patient’s decision and was performed with the intention of complete removal of the lesion with adequate margins in each case.

      Result

      Mean follow-up duration was 55 months in the 12 patients, and median time to local recurrence was 27 (range, 15-60) months after surgery in the 4 patients. Pathological re-examination in the 4 patients revealed a diagnosis of adenocarcinoma with a mean invasion zone size of 0.68 (range, 0.18-1.4) cm. The distances of margins determined pathologically were shorter than those intended perioperatively; margins were positive in 3 of the 4 specimens. Although the edges of the 0.6-cm margins around the primary lesion were negative, numerous tumor cells were observed in the remaining 1 specimen.

      Conclusion

      In wedge resection, it is difficult to identify accurate surgical margins of the GGO lesion and to detect multiple lesions near the surgical margin without palpation. Thus, surgical margins at VATS wedge resection determined solely by visual inspection can be inadequate and may result in incomplete removal of the lesion.

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