To identify the benefits of limited surgery on small-sized lung tumors, the following subjects are discussed: 1) an updated report from a prospective group study (January 1992-December 1994) for extended segmentectomy for small lung tumors (n = 55); 2) a histopathological study of resected adenocarcinoma specimens less than 2 cm in size (n = 94), proposed by Noguchi; and 3) lung function after limited surgery and the quality of video-assisted thoracoscopic surgery.
Results: 1) Among 10 deaths, 4 patients died of their disease including one with local recurrence. The survival rate at 5 years was 91%, not including 6 unrelated deaths. 2) Of 94 patients, twelve with localized bronchioalveolar tumors (type A and B), and 23 of 57 patients with active fibroblastic proliferation (type C), underwent extended segmentectomy. Those 35 patients are all free of disease. The remaining 59 patients had a 70% 5-year survival rate. 3) Forced vital capacity was maintained at 92% of the preoperative level, which was much better than 81% for patients undergoing lobectomy. Card-sized thoracotomy using a thoracoscope was carried out in 92 patients, including 21 patients who underwent segmentectomy, in a series of 175 consecutive lung cancer operations. This approach resulted in less bleeding, the same operating time, and better preservation of vital capacity.
Conclusions: Extended segmentectomy for small lung tumors did not affect the prognosis, and was associated with a better quality of life postoperatively.