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Sawabata et al. Pulmonary wedge resection for NSCLC

mortality rates. However, technical limitations and sublobar resection of stage I NSCLC is improving,
complications associated with SBRT, including “no-fly- and is not significantly different globally for peripheral
zone”, irradiation of hilar tumors, pulmonary fibrosis, small-sized tumors; (2) there are phase III studies
and hemoptysis should be considered when comparing comparing lobectomy and segmentectomy but not
surgery to SBRT. Moreover, in many studies, patients wedge resection; (3) survival probability of wedge
with unknown histologic diagnosis received SBRT. resection seems to be similar to that of SBRT, but
However, in order to perform SBRT, the lesion should SBRT has limitations such as “no-fly-zone”, irradiation
be diagnosed cytologically and/or pathologically. of hilar tumors and associated complications such as
Because diagnosing a cancer lesion involves some pulmonary fibrosis and hemoptysis; and (4) a suitable
interventions, it is necessary to consider the merits and subgroup of patients for wedge/sublobar resection
demerits of each diagnostic procedure. may be found based on tumor size, location, margin-
distance, M/T ratio, and margin cytology.
There are three main methods used to diagnose lung
cancer are transbronchial biopsy with flexible fiber- Authors’ contributions
topic bronchoscopy (FFB), CT-guided fine needle Organizing this review and writing: N. Sawabata
aspiration biopsy (FNAC), and surgical resection. [67] Making a discussion and comments on the context of
Each method is important but has some drawbacks. this review: A. Kawase, N. Takahashi, T. Kawaguchi,
FNAC has potential to disseminate cancer cells through N. Matsutani
the needle tract. [68] In a clinical settings, it has been
reported that the relapse rate due to pleural recurrences Financial support and sponsorship
is higher in FNAC than other diagnostic methods. [69,70] None.
There are also reports that reveal a prognostic
disadvantage of biopsy using FFB. [71,72] Pulmonary Conflicts of interest
wedge resection is also a useful diagnostic technique There are no conflicts of interest.
for pulmonary nodules suspicious of malignancy, in
addition to complete lesion resection with sufficient Patient consent
margin. As such, wedge/sublobar resection may be
more suitable than SBRT in operable patients with no Not applicable.
pathological diagnosis, and a select group of patients
even if the cytological and/or pathological diagnosis is Ethics approval
attained. In addition, if surgeons decide to carry out Not applicable.
sampling of suspicious lymph nodes as in ACOSOG
Z4032, knowledge of lymph node metastasis can REFERENCES
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20 Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017