Background：We present wedge resection as an alternative procedure for primary pulmonary carcinoma in poor-risk patients. Patients and Methods：We examined the overall survival of 94 patients who underwent wedge resection for pN0M0 primary pulmonary carcinoma over the last 20 years because of their intolerance of lobectomy. Results：In the wedge resection group, the postoperative 5-year survival in all causes of death was 59.6％， indicating significantly better prognoses in patients with adenocarcinoma aged less than 75 years old. The 5-year survival in the lobectomy group was 77.5％， while the 5-year survival in terms of primary causes of death in the wedge resection and lobectomy groups was 89.3％ and 88.0％， respectively. There was a significant difference between wedge resection and lobectomy in all causes of death, but not between groups in primary causes of death. Conclusion：Because there were many non-primary deaths in the wedge resection group, care should be taken to follow comorbidities that cause limited lung resection. Survival in the wedge resection group was not inferior to that in the lobectomy group in analyses of the primary causes of death. We suggest that wedge resection should be a favorable procedure for primary pulmonary carcinoma in poor-risk patients to obtain a large enough sample volume of tumor cells.

Background：The standard approach for treating recurrence after complete resection of primary non-small cell lung cancer has been controversial. We present here a multidisciplinary strategy for postoperative recurrence in patients with primary lung cancer． Patients and Methods：Over the last 7 years, we examined the disease-free survival and overall survival of 70 patients who underwent multidisciplinary treatment for recurrence after surgical resection of primary lung cancer． Results：The median overall survival was 32.3 months after surgery and 17.4 months after recurrence developed, indicating significantly better prognoses in females and in patients with adenocarcinoma, stage I disease, driver mutation positivity, a longer postoperative disease-free period, and never smokers. Eight patients survived more than 5 years after recurrence；of these patients, all had adenocarcinomas, 7 had oligometastases and/or tumor dormancy, and 5 received multiple-drug regimens．Conclusion：Multidisciplinary treatment for recurrence after resection of primary lung cancer was effective for patients receiving various drug regimens. In patients with oligometastases, disease control was achieved by a combination of local treatments targeting each involved organ. In patients with tumor dormancy, follow-up or a drug holiday was important to maintain the patient’s quality of life．

Purposes：To assess the independent predictor of lymph node metastasis（ LNM） in peripheral smallsized non-small cell lung cancers （NSCLCs）, we conducted a clinicopathologic analysis of patients with small-sized NSCLCs with and without intrathoracic LNM. Methods：We retrospectively studied 213 patients who had undergone surgical resection of NSCLCs 20 mm or less in diameter. Categories of patient characteristics were divided into 2 groups based on clinicopathologic features, and the incidence of LNM was compared. Univariate and multivariate analyses of factors affecting overall survival（ OS） were also conducted. Results：In pN1-2 group （n＝19）, the incidence of elevated （＞5 ng/dl） of preoperative carcinoembryonic antigen （CEA） and larger tumor size （＞10 mm） was significantly higher than that in pN0 group （n＝194） ［p＝0.0004, 0.0025］. Preoperatively, 73.7％ patients were diagnosed as having lower stage in N-staging. Multivariate analysis identified only pN staging as an independent prognostic factor （p＝0.002）. Conclusions：It is likely that preoperative CEA and tumor size are useful in selecting patients with micro-N1-2 disease among those with small-sized NSCLCs. Our results indicate that limited resection should be avoided in patients with elevated CEA or tumors more than 10 mm in size, even if preoperative radiographic findings suggest no intrathoracic LNM.