Introduction: A sublobar resection is performed on patients with non-small cell lung cancer (NSCLC) who are not candidates for a lobectomy due to reduced pulmonary function or comorbid disease. The aim of this study was to investigate the outcomes of these operations in Iceland.

Material and methods: A retrospective study of all patients with NSCLC who underwent wedge resection or segmentectomy with curative intent during 1994-2008. Data on indication, pathological TNM-stage, complications and overall survival was analyzed. All histological samples were re-evaluated.

Results:Forty four patients underwent 42 wedge and 5 segmental resections (age 69.1 yrs, 55.3% female), with 38.3% of cases detected incidentally. The majority of patients (55.3%) had a history of coronary artery disease and 40.4% had chronic obstructive pulmonary disease. Mean operative time was 83 minutes (range 30-131), mean intraoperative bleeding was 260 ml (range 100-650) and median hospital stay was 9 days (range 4-24). Pneumonia (14.9%) and prolonged air leakage (12.8%) were the most common complications. Two patients had major complications and 36.2% stayed in the intensive care unit overnight. No deaths occurred within 30 days of surgery. Adenocarcinoma was the most common histological type (66.7%). Most cases were stage IA/IB (78.7%), 17.0% were stage IIA/IIB and 4.3% were stage IIIA. One and 5 year survival was 85.1% and 40.9% respectively.

Conclusion: In Iceland, both survival and complication rate after sublobar resection for NSCLC are comparable to results published for lobectomies, even though a higher percentage of patients have underlying cardiopulmonary disease.

Alexandersson A, Jonsson S, Isaksson HJ, Gudbjartsson T

Key words: sublobar resection, wedge resection, segmentectomy, NSCLC, complications, survival.

Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is

Table I. Clinical information on the preoperative status of 44 patients who underwent 47 sublobar resections for NSCLC in Iceland 1994-2008. The number of cases with % in parenthesis is shown. Percentages are calculated for 47 procedures and not patients. Spirometry values were missing in eight cases.

Information	n (%)
Smoking history	46 (97.9)
COPD	19 (40.4)
FEV1 <75% of predicted	(41.0)
FVC <75% of predicted	(33.3)
Coronary artery disease	26 (55.3)
History of arrhythmia	8 (17.0)
ASA* score
I	2 (4.3)
II	15 (31.9)
III	29 (61.7)
IV	1 (2.1)

*American society of Anesthesiologists

Table II. Complications in 44 patients who underwent 47 sublobar resections for NSCLC in Iceland 1994-2008. Patients can have more than one complication. The number of cases with % in parenthesis is shown. Percentages are calculated for 47 procedures.

Complications	n (%)
Minor complications	18 (38.3)
Pneumonia	7 (14.9)
Prolonged air leakage (>7 d.)	6 (12.8)
UTI	5 (10.6)
Intraoperative bleeding >500 ml	4 (8.7)
Wound infection	2 (4.3)
Atrial fibrillation	1 (2.1)
Arterial line infection	1 (2.1)
CHF	1 (2.1)
Major complications	2 (4.3)
Myocardial infarction	1 (2.1)
Stroke	1 (2.1)
Mortality:
<30 days	0
<90 days	1 (2.1)

 

Table III. Comparison of results between this study of 44 patients who underwent 47 sublobar resections for NSCLC in Iceland 1994-2008 and a study of 213 patients who underwent lobectomy for NSCLC in Iceland 1999-2008.(11, 12) The number of cases with % in parenthesis is shown except for averages and overall survival. Percentages for sublobar resections are calculated as a proportion of 47 cases.

	Sublobar resections (present study)	Lobectomies	P-value
Study period	1994-2008	1999-2008
Number of cases	47	213
Proportion with stage I disease	37 (78.7)	127 (59.6)	<0.02
Mean age (years)	69.1	66.9	0.17
Mean tumour size (cm)	2.3	3.7	<0.001
Mean ASA-score	2.6	2.6	0.74
Coronary artery disease	26 (55.3)	55 (25.8)	<0.001
COPD	19 (40.4)	60 (28.2)	0.12
Mean operative time (min)	83	128	<0.001
Mean intraoperative bleeding (ml)	260	580	<0.001
Major complications	2 (4.3)	16 (7.5)	0.54
Death <30 days (operative mortality)	0	0
Overall survival   1 year   5 year	85.1% 40.9%	82.7% 45.1%	0.93

Figure 1. The location, in the lungs, of tumours excised from 44 patients who underwent 47 sublobar resections for NSCLC in Iceland 1994-2008. All together 48 tumours were removed. The number of tumours with % in parenthesis is shown.

Figure 2. Pathological TNM stage of cases for 44 patients who underwent 47 sublobar resections for NSCLC in Iceland 1994-2008.

Figure 3. Overall survival of 44 patients who underwent 47 sublobar resections for NSCLC in Iceland 1994-2008.