• Kuan-Chuan Tsou, Hsao-Hsun Hsu, Tung-Ming Tsai, Ke-Cheng Chen, and Jin-Shing Chen.
• Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan; Department of Surgery, Taipei City Hospital, Zhongxiao Branch, No.145, Zhengzhou Rd., Datong Dist., Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
• J Formos Med Assoc. 2020 Jan 1; 119 (1 Pt 3): 399-405.

Background/PurposeNon-small cell lung cancer (NSCLC) presenting as subcentimeter lung tumor was increasing due to the popularity of low dose CT in recent years. However, the ideal surgical management is still controversial. We utilized our lung cancer surgery database to study the important issue, aiming to find the optimal treatment with VATS.MethodsFrom January 2010 to December 2015, we retrospectively reviewed the clinical characteristics, staging, operation methods, and outcomes of 424 patients with subcentimeter lung cancer. Three groups distinguished by surgical methods were compared.ResultsThere are 273, 57, and 94 undergoing VATS wedge resection, segmentectomy, and lobectomy, respectively. Of the nine recurrence or metastasis events, seven and two occurred within the wedge resection and lobectomy groups, respectively. The average follow-up time is 779 days (2.16 years). Furthermore, 97.4%, 100%, and 97.9% of patients in the wedge resection, segmentectomy, and lobectomy groups, respectively remained tumor-free during follow-up. The complication rate of approximately 1.5% did not differ significantly between the three groups. An obvious difference in disease-free survival between the three groups (p-value = 0.027; -2 log likelihood score and chi-square test). No cases of recurrence or metastasis were observed in the segmentectomy group.ConclusionLung cancer with subcentimeter size will be more and more encountered. VATS plays an important role in the management with good post-operative outcome, whether with wedge resection, segmentectomy and lobectomy. However, VATS segmentectomy can deliver 100% overall survival and progression-free survival in our series. Further randomized controlled trial should be conducted to prove the concept.Copyright © 2019. Published by Elsevier B.V.

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