Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens

• Published in: American journal of clinical pathology Vol. 120; no. 5; pp. 720 - 724
• Main Authors: GOLDSTEIN, Neal S, FERKOWICZ, Monica, KESTIN, Larry, CHMIELEWSKI, Gary W, WELSH, Robert J
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Society of Clinical Pathologists 01.11.2003
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Biological and medical sciences; Humans; Lung - pathology; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Medical sciences; Pneumonectomy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Adenocarcinoma; Human; Lung disease; Wedge resection; Respiratory disease; Lung; Malignant tumor; Wedge; Treatment; Surgery; Technique; Lobectomy; Margin
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1309/p47fyw5u4crq0wfe

We studied 31 T1 N0 M0 peripheral adenocarcinomas diagnosed by wedge resection and treated by lobectomy. Factors recorded were pleural surface-based, gross cut-surface, and microscopic margin distances; morphologic features of the adenocarcinomas; microscopic extension distance of beyond gross perimeter of neoplasm; and presence of residual adenocarcinoma in the lobectomy specimen. All staple-line margins in the wedge and lobectomy specimens underwent complete histologic examination. The mean pleural surface-based, gross cut-surface, and microscopic margin distances in wedge resections were 13.1, 4.1, and 2.3 mm, respectively. The mean microscopic wedge resection margin distance was 11 mm smaller than the pleural surface-based measured margin. The mean microscopic lepidic growth beyond the gross perimeter of the neoplasm was 7.4 mm. Fourteen lobectomy specimens (45%) included adenocarcinoma. The mean microscopic wedge resection specimen margin distances in cases with and without residual adenocarcinoma in the lobectomy specimens were 0.7 and 2.4 mm, respectively (P < .001). Incomplete excision may contribute to higher locoregional recurrence rates following limited resection surgery. Two processes affected wedge resection margin distances: stapling-induced parenchymal stretching, resulting in overestimation of pleural surface-based distances, and microscopic extension of adenocarcinoma beyond the gross perimeter of the neoplasm.