Surgical Management of Non-Small Cell Lung Cancer Invading the Fissure: Less Is More?

Background: When a resectable lung cancer that invades across the fissure into an adjacent lobe is encountered, options include a bilobectomy on the right or a pneumonectomy on the left vs a parenchymal-sparing resection combined with a lobectomy. Although parenchymal-sparing combinations are technically possible, the available literature reporting on the related oncologic outcomes is limited. We sought to examine the influence of resection extent on overall survival and recurrence patterns in this scenario. Methods: A single-center retrospective medical record review from 2006 to 2018 was performed on all preoperative computed tomography and operative reports of resections greater than a lobectomy. Patients were grouped into maximal resection: bilobectomy or pneumonectomy, and parenchymal-sparing resection: lobectomy with en bloc segment or nonanatomic wedge. Overall survival and cumulative incidence of recurrence were calculated. Results: The size of our cohort was 54 patients; 19 maximal and 35 parenchymal-sparing resections. All resections were reported as complete (R0). The parenchymal-sparing group had lower odds of immediate surgical morbidity (odds ratio, 0.13; 95% confidence interval, 0.02-0.74; P = .02). Parenchymal-sparing resection was not associated with an increased cumulative incidence of recurrence (P = .98). Postresection estimated overall survival between the 2 cohorts was not significantly different (P = .30). Conclusions: When technically feasible, a parenchymal-sparing resection is a good option for the resection of tumors that invade across the fissure. R0 parenchymal-sparing resections do not appear to compromise the oncologic outcomes of overall survival or cumulative incidence of recurrence and also seem to carry less morbidity.