Lung cancer is the most common cause of cancer-related mortality in developed countries and paralell to this fact, the human population is getting older, there are more and more old patients living with severe comorbodities. Thanks to this and the frequently late stage tumors, only 30% of these patients are candidates for radical lung surgery, which is is the only one known curative treatment method. With the decrease of smoking, the clinicopathological features of lung cancer have been changed and with the widespread use of chest CT and different screening methods, there are more and more small, early-stage lung cancers diagnosed. The gold standard surgical care for lung cancer is lobectomy, but on the part of thoracic surgeons, there is a natural need to perform sublobar, more parenchma-preserving resections, on the basis of which more patients diagnosed with small, early-stage tumors become suitable for surgery. Nowadays, segmentectomy, the anatomical sublobar resection is used not only for the high-risk patients, the radiomorphological and histological criteria of indication are outlined. Performing segmentectomy might be challenging, mainly during VATS, in these cases the use of ICG, NIR fluorescens-guided surgery is very useful.
In our retrospective study we studied the changes in the clinicopathological features of surgically treated lung cancer around the millenium. We compared the clinicopathological features of lung resection cases carried out in our department of 2 different 5-year periods. The earlier period was defined as operations performed between 01.01.1998 and 31.12.2002, while the later one was between 01.01.2008 and 31.12.2012. There was no difference in the age and smoking habits, but the ratio of women has increased from 27% to 43%. The ratio of adenocarcinomas has increased from 40% to 62,5%, while the percent of squamous cell carcinomas has decreased. Analyzing the different surgical methods, we can see that the rate of pneumonectomies decreased from 27.1% to 9.4%. Parallel to this fact, the rate of lobectomies and sleeve lobectomies increased from 58% to 75.2%. During the second period thoracoscopy became the method of choice for lobectomies too. In the first period only minor resections, atypical wedge resections were carried out via thoracoscopy. There was no anatomical segmentectomy performed during the first period, while 3.2% of patients had segmentectomy in the second one. The ratio of I/A stage carcinomas shows significant change, it has risen from 17,5% to 32,7%. 5-year survival was similar in both periods.
There are many articles in the literature about the selection criteria of lung segmentectomy. Nowadays, we can say that patients otherwise fit for lobectomy can be also candidates for segmentectomy, it is not only a „compromise” procedure any more. Basic radiomorphological criterias are the followings, first at least 1cm tumor-free resection margin and secondly the tumor size, which cannot be larger than 2 or 3 cm. By CT morphology, by the presence and feature of Groung Glass Opacity sometimes we can conclude on the histology and the grading of the lung cancer. Segmentectomy is usually indicated for adenocarcinomas, where we can identify many histological subgroups and the histological pattern is usually mixed. Haematoxylin-eosin slides of consecutive patients having pulmonary adenocarcinoma in stage I were analysed in our retrospective cohort study II. All available tumour containing slides were digitalized. In the first step, the proportions of growth patterns were estimated in 5% increments, and the predominant, secondly and thirdly predominant components were determined with naked eye evaluation. In the second step, the different patterns of the entire tumour were annotated and their areas were measured in square millimetre. The proportions of each component were calculated from the measured areas. The median follow-up was 61.5 months (range 1.5– 175.3 months). Significant differences in survival rates were found in association with proportions of lepidic pattern (better survival) and proportions of micropapillary or solid patterns (worse survival). With the 5% cut-off point, significant differences in survival were observed in lepidic, solid and micropapillary patterns, and with the 1% cut-off point in lepidic and solid patterns. Our results confirm the evidence that lepidic predominant carcinoma has a favourable prognosis, but there was no difference in overall or disease-free survival between tumours with secondly predominant lepidic component and tumours without lepidic component. A difference was found between the mean proportion of lepidic component of tumours with recurrence (8%) and those without recurrence (20%). A significant difference was observed between overall and tumor-free survival of tumours having ≥5 or ≥ 1% solid component and those having less. Similarly, significant differences were found in OS and DFS between various comparisons of tumour