Clinical usefulness of the 3-tier classification according to the proportion of morphological patterns for patients with pathological stage I invasive lung adenocarcinoma.

OBJECTIVES: We classified pathological stage I invasive lung adenocarcinomas according to our 3-tier classification, which was based on the proportion of invasive morphological patterns as follows: (1) patients with each predominant subtype, (2) those with a minor histological subtype, even not the predominant subtype and (3) those without each invasive component. We aimed to evaluate the classification's clinical impact in survival, recurrence, malignant grade, and epidermal growth factor receptor (EGFR) mutational status. MATERIALS AND METHODS: A total of 1,269 patients with p-stage I lung adenocarcinoma underwent curative surgical resection between January 2008 and December 2017. Of these, 620 patients (48.9%) met the inclusion criteria of this study. RESULTS: Postoperative recurrence was observed in 81 patients (13.1%). Multivariate analysis showed that vascular invasion (hazard ratio, 2.61; p < 0.001) and p-stage IB (hazard ratio, 2.19; p = 0.001) were significantly associated with an unfavorable RFS, while the presence of acinar component (hazard ratio, 1.64; p = 0.052) or solid component (hazard ratio, 1.60; p = 0.074) were marginally significant. The presence of lepidic or papillary component and the absence of acinar or solid component significantly correlated with an increased proportion of lung adenocarcinomas harboring EGFR mutations. CONCLUSION: In patients with p-stage I invasive lung adenocarcinoma, it is beneficial to use not only the predominant subtype but analyzing the extent of each histological component based on our classification to predict patient prognoses and form appropriate postoperative follow-up methods.

Powered articulation by the SigniaTM stapling system for stapling position adjustments: optimizing safe surgical margins in thoracoscopic sublobar resection.

Accumulation of experience and advances in techniques and instruments have enabled surgeons to perform video-assisted thoracic surgery (VATS) safely for sublobar resection, including segmentectomy and wedge resection. A key to successful VATS sublobar resection is to have adequate resection margins and the appropriate use of articulated surgical staplers is essential for this purpose. The SigniaTM stapling system (Covidien Japan, Tokyo) has been used extensively in the fields of thoracic surgery. Its features include high maneuverability with fully powered articulation, rotation, clamping, and firing, which the surgeon can control with one hand. We introduce the "sliding technique" using the SigniaTM system, which allows for adjustment of the resection lines of the pulmonary parenchyma to optimize safe surgical margins with minimal stapler movement, and without repetitively moving the stapler in and out of the pleural cavity, during VATS sublobar resection.

Which Window Setting Is Best for Estimating Pathologic Invasive Size and Invasiveness?

BACKGROUND: In the Eighth Edition of the Tumor Node Metastasis Classification System for Lung Cancer, the definitions of the clinical T and pathologic T descriptors have changed. Little has been reported on comparisons between the consolidation diameter in the lung window setting and the tumor diameter in the mediastinal window setting with respect to the correlations with pathologic invasive size (IS) and invasiveness. The present study was conducted to clarify which window setting was better for preoperatively estimating IS and invasiveness. METHODS: We retrospectively reviewed 1,167 consecutive patients with lung adenocarcinomas measuring 3 cm or less in diameter. We measured three high-resolution computed tomography variables and examined correlations of IS with these variables, factors predictive of an IS of 5 mm or less, and other variables related to invasiveness. RESULTS: On receiver operating characteristic curve analysis, the tumor diameter in the mediastinal window setting more strongly predicted IS than did the consolidation diameter in the lung window setting (p < 0.001), and the consolidation diameter in the lung window setting more strongly predicted IS than did the maximum tumor diameter in the lung window setting (p < 0.001). Lymphatic, vascular, and pleural invasion were best predicted by the tumor diameter in the mediastinal window setting. CONCLUSIONS: We can estimate IS and other variables related to invasiveness most precisely by measuring the tumor diameter in the mediastinal window setting. The tumor diameter in the mediastinal window setting is an important variable that we should measure preoperatively.