1998 Volume 12 Issue 7 Pages 756-761
We analyzed resected non-small cell lung cancer cases with intrapulmonary metastasis to the primary lobe (pml cases) in order to evaluate the feasibility of intentional limited surgery for small peripheral non-small cell lung cancer. Forty-six cases with pml were treated between 1975 to 1996. Thirty-two patients had adenocarcinoma, 10 squamous cell carcinoma, 2 adenosquamous cell carcinoma, and 2 large cell carcinoma. Tumor diameters of the primary lesions were as follows : only 1 case of squamous cell carcinoma had a diameter of less than 3.0 cm, compared with 7 cases of adenocarcinoma whose diameter was from a minimum 1.0 cm to 3.0 cm. Concerning the relation of pm with p and N factors, p0 was found in 47% of adenocarcinoma cases and 40% of squamous cell carcinoma, and N0 was seen in 38% of adenocarcinoma cases and 30% of squamous cell carcinoma cases. It was thus considered difficult to presume the presence of pm from p and N factors. Diagnosable rate of pm before and during surgery was low, and the presence of pm was diagnosed for the first time by postoperative pathological investigation in 66% of cases of adenocarcinoma and 40% of squamous cell carcinoma. In the pre-operative clinically morbid period, 5 cases of adenocarcinoma were diagnosed as c-T1N0M0, but there was no case of squamous cell carcinoma that was diagnosed as T1N0M0. As result of investigating 5 cases who were diagnosed as c-T1N0M0, all the cases were diagnosed as PM0 even during surgery. The tumor diameters in 4 of 5 cases were larger than 2.0 cm. The pms in these cases were present in the same segment as the primary lesion, but in the other 1 case, the tumor diameter was 1.5 cm, and pm was present in the segment different from the primary lesion. Furthermore, this case was NO and could have been defined as a case for whom limited surgery is applicable, and there was a strong possibility of letting pm subsist.
From the above, we concluded that limited surgery on peripheral small early lung cancer can be established as the standard surgery for squamous cell carcinoma, but the application of limited surgery to adenocarcinoma must be carefully considered.
