Supplement: 2nd International Bi-Annual Minimally Invasive Thoracic Surgery Summit
Section III: Lung cancer—other perspective
Safe and Effective Minimally Invasive Approaches for Small Ground Glass Opacity

Presented at the 2nd International Bi-Annual Minimally Invasive Thoracic Surgery Summit, Boston, MA, October 9–10, 2009.
https://doi.org/10.1016/j.athoracsur.2010.03.075Get rights and content

Background

Popularized computed tomography physical check up results in an increasing number of patients with ground glass opacity (GCO) lesions of which management has not been established yet.

Methods

From January 2004 to December 2008, 738 patients underwent pulmonary resection for primary lung cancer, and 96 (13.0%) with resected GGO lesions were included in this study. Pure GGO lesions sized less than 10 mm are monitored until they grow bigger or develop a core. Three-port video-assisted thoracic lobectomy with systematic lymph node dissection is indicated when the lesion diameter exceeds 15 mm or is invasive, and segmentectomy is indicated when the tumor diameter is 10 to 15 mm. Wedge resection is indicated when the tumor is peripherally located.

Results

There was no procedurally related mortality or morbidity. There were 9 papillary adenocarcinomas or invasive bronchioloalveolar carcinomas, 75 noninvasive bronchioloalveolar cell carcinomas, 7 atypical adenomatous hyperplasias, and 5 organizing pneumonias. No local recurrence was observed.

Conclusions

Several pathologies are included in GGO lesions, and the video-assisted thoracic approach seems to be one of the best options in their management.

Section snippets

Material and Methods

This retrospective study was approved by the Toranomon Hospital Institutional Review Board of Clinical Research. The need for informed consent from patients was waived because of its retrospective design.

Results

There were no procedurally related deaths. The final pathology included papillary adenocarcinomas or BAC type C in 9 (Fig 3), BACs type A or B in 75 (Fig 4), AAHs in 7 (Fig 5), and organizing pneumonias in 5 (Fig 6;Table 1). No relation was found between the HRCT findings and the final pathology. Eleven BACs diagnosed as noninvasive by intraoperative frozen section examination were BACs type C, invasive lesions at the final diagnosis. No patients had had local recurrences. No recurrence was

Comment

Recent advances in physical check up with CT and widespread use of CT for evaluation of lung pathology in Japan has increased the number of patients we have encountered with so-called GGO lesions. Some of the lesions are ordinarily papillary adenocarcinomas, some are noninvasive BACs, some are AAHs, and some are organizing pneumonias. The treatment option should be different according to its pathology. The correlation between GGO lesions on HRCT and pathologic findings has been studied [6];

Cited by (31)

  • Management of Intraoperative Difficulties During Uniportal Video-Assisted Thoracoscopic Surgery

    2017, Thoracic Surgery Clinics
    Citation Excerpt :

    The presence of calcified hilar and/or periarterial lymph nodes can complicate vascular dissection: the key in these cases is to find the adventitial plane.14 Then, through bimanual instrumentation, the dissection can be performed with simple instruments (curved forceps, long scissors, suction and a conventional dissector); in really complex situations is possible to staple 2 anatomic structures together as described by Kohno and colleagues.28 A previous ipsilateral surgery is also no longer a contraindication, because good outcomes of redo VATS surgery have been reported.29

  • Lipiodol lOcalization for Ground-glass opacity mInimal Surgery: Rationale and design of the LOGIS trial

    2015, Contemporary Clinical Trials
    Citation Excerpt :

    For surgical biopsy, VATS has become the optimal method for the diagnosis and treatment of pulmonary nodules because of its minimal invasiveness and safety [12,32]. In addition, in patients for whom surgical resection is considered appropriate, data strongly suggest that limited VATS wedge or segmental resections may be considered in place of a standard lobectomy [33,34]. However, conversion to thoracotomy because of localization failure is common, and it is the most common cause of VATS failure [24].

  • Nodule Characterization. Subsolid Nodules.

    2014, Radiologic Clinics of North America
    Citation Excerpt :

    Although with 100% or near 100% 5-year disease-free survival rate of AAH, AIS, and MIA have been reported, greater understanding is needed to further refine indications for surgery.3 More immediately, although still controversial, a number of studies have supported limited sublobar resection, including wedge resection and segmentectomy for subsolid nodules measuring 2 cm or smaller in place of lobectomy, with no significant difference in survival and locoregional recurrence rates.28,87,97,138–143 For example, in a 13-year analysis study by El-Sherif and colleagues,142 there was no significant difference between survival and recurrence rates in the sublobar and lobar resection groups.

View all citing articles on Scopus
View full text