Two major principles of lung cancer surgery: maximum tumor removal and maximum preservation of lung function
According to the guidelines, surgery is usually the first choice for patients with non-small cell lung cancer (NSCLC) with clinical stages I-II and some stage IIIa.
Lung cancer surgery follows the principle of “two maxims”: maximum tumor removal and maximum preservation of lung function.
Three outcomes of lung cancer surgery: complete resection, incomplete resection, and indeterminate resection
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Can all lung cancer surgeries be “clean”? No. Depending on the outcome, there are three types of surgery. Depending on the outcome of the resection, there are three types of surgery.
“Negative” means there is no tumor left and the surgery is “clean”; “positive” means there is tumor left or cancer cells are found under the microscope.
1. Complete resection
- Negative margins, including bronchial, arterial, venous, peribronchial, and tumor-adjacent tissues;
- Lymph node dissection of at least 6 groups, including 3 intrapulmonary groups; 3 mediastinal groups (must include zone 7);
- The highest “grade” lymph node removed, which is microscopically negative;
- No invasion outside the lymph nodes.
- No invasion outside the lymph nodes.
The figure above illustrates the distribution of lymph nodes at various stations of the lung.
N2 lymph nodes: including upper mediastinal lymph nodes (stations 1~4) and lower mediastinal lymph nodes (stations 7~9).
N1 lymph nodes: including stations 10~14, of which stations 11~14 are intrapulmonary lymph nodes.
For complete resection, 3 groups of N2 lymph nodes (station 7 must be included) and 3 groups of intrapulmonary lymph nodes should be removed.
2. Incomplete resection
- positive cut margins;
- Cancer cells were detected within the pleural effusion or pericardial effusion;
- Tumor invasion outside the lymph nodes;
- positive lymph nodes, but not resectable.
3. Indeterminate resection
The cut margin is negative microscopically, but one of the following occurs.
- Lymph node dissection was not achieved;
- The highest mediastinal lymph node resected is positive;
- Bronchial cut margins are carcinoma in situ;
- Positive cytology in the chest washout fluid.
Currently, the standard for lung cancer surgery is to achieve complete resection.
Related reading.
Co-authors: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Tao Zhang Dr. Jing-Hua Chen