• Amgad El-Sherif, Hiran C Fernando, Ricardo Santos, Brian Pettiford, James D Luketich, John M Close, and Rodney J Landreneau.
• Division of Thoracic Surgery and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
• Ann. Surg. Oncol. 2007 Aug 1;14(8):2400-5.

BackgroundLocal recurrence is a major concern after sublobar resection (SR) of non-small cell lung cancer (NSCLC). We postulate that a large proportion of local recurrence is related to inadequate resection margins. This report analyzes local recurrence after SR of stage I NSCLC. Stratification based on distance of the tumor (<1 cm vs >or=1 cm) to the staple line was performed.MethodsWe reviewed 81 NSCLC patients (44 female) who underwent operation over an 89-month period (January 1997 to June 2004). Mean forced expiratory volume in one second percentiles (FEV1) was 57%. Mean age was 70 (46-86) years. There were 55 wedge and 26 segmental resections. There were 41 tumors with a margin <1 cm and 40 with a margin >or=1 cm. Local recurrence was defined as recurrence within the ipsilateral lung or pulmonary hilum.ResultsThere were no perioperative deaths. Mean follow-up was 20 months. Margin distance significantly impacted local recurrence; 6 of 41 patients (14.6%) developed local recurrence in the group with margin less than 1 cm versus 3 of 40 patients (7.5%) in the group with margin equal to or more than 1 cm (P = .04). Of the 41 patients with margins <1 cm, segmentectomy was used in 7 (17%), whereas in the 40 patients with the >or=1 cm margins, segmentectomy was used in 19 (47.5%).ConclusionsMargin is an important consideration after SR of NSCLC. Wedge resection is frequently associated with margins less than 1 cm and a high risk for locoregional recurrence. Segmentectomy appears to be a better choice of SR when this is chosen as therapy.

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