Do Pathologic Margins Matter in Anatomic Lung Resections?

Presented During:

Monday, May 8, 2023: 4:00PM - 4:15PM
Los Angeles Convention Center  
Posted Room Name: 408B  

Abstract No:


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Abstract Submission 


Kunaal Sarnaik (1), Allison Gasnick (1), Aria Bassiri (2), Craig Jarrett (2), Jillian Sinopoli (2), Leonidas Tapias Vargas (2), Philip Linden (2), Christopher Towe (2)


(1) Case Western Reserve University School of Medicine, Cleveland, OH, (2) University Hospitals Cleveland Medical Center, Cleveland, OH

Submitting Author:

Kunaal Sarnaik    -  Contact Me
Case Western Reserve University School of Medicine


Allison Gasnick    -  Contact Me
Case Western Reserve University School of Medicine
Aria Bassiri    -  Contact Me
University Hospitals Cleveland Medical Center
Craig Jarrett    -  Contact Me
University Hospitals Cleveland Medical Center
Jillian Sinopoli    -  Contact Me
University Hospitals Cleveland Medical Center
Leonidas Tapias Vargas    -  Contact Me
University Hospitals Cleveland Medical Center
*Philip Linden    -  Contact Me
University Hospitals Cleveland Medical Center
Christopher Towe    -  Contact Me
University Hospitals Cleveland Medical Center

Presenting Author:

Kunaal Sarnaik    -  Contact Me


Objective: Close margin distance after wedge resection has been associated with lung cancer recurrence and death. The relationship between pathologic margin and recurrence has not yet been established after anatomic lung resection. We hypothesized that close pathologic margin after anatomic lung resection would not be associated with decreased overall survival.

Methods: Detailed pathology reports were extracted among patients receiving anatomic lung resection at a single institution between 2014-2021. Patients with "distance to closest margin" documented were included. Patients with pathologic metastatic disease were excluded. "Close" pathologic margin was defined as closest pathologic margin <1cm. The outcome of interest was overall survival defined as time from surgery to last follow up or death, which was calculated using state Death Record Indices. Kaplan-Meier survival estimates were performed using log rank test. Multivariable cox proportional hazard analysis was performed, including an interaction analysis, to evaluate close pathologic margin in each "extent of resection": lobectomy, segmentectomy, bilobectomy, pneumonectomy.

Results: Among 246 patients included in the study, 97 (39.4%) had a close pathologic margin. The average margin was 1.87cm (median 1.2cm, IQR 0.5-2.6cm). Close margin status did not vary by extent of resection, or nodal status, but was more likely with higher T-stage tumors (T1 36.8%, T2 28.6%, T3 58.8%, T4 66.7%, p=0.004). Median follow-up was 2.4 years and did not vary by margin status (p=0.399). Overall survival was not decreased among patients with a close margin (Figure 1, p=0.367). In a multivariable cox hazard analysis of overall survival, close margin was not associated with decreased overall survival (HR 0.457, p=0.087), while CHF (HR 4.45, p=0.002), T4 tumors (HR 8.67, p=0.001) and nodal metastasis (HR 4.90, p<0.001) were associated with decreased survival. A multivariable interaction analysis between anatomic margin and extent of resection did not demonstrate decreased survival associated with close pathologic margin among patients receiving segmentectomy (relative to >1cm margin and lobectomy – HR 0.356, p=0.345).

Conclusions: Close pathologic margins are not associated with increased risk of death after anatomic lung resections. In the setting of CALGB 140305, sublobar anatomic lung resection may be increasingly safely performed, and negative pathologic margins after segmentectomy are likely sufficient.


Lung Cancer

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Supporting Image: Anatomic_Resection_Margin_PIC.png

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Procedural Techniques


Keywords - General Thoracic

Lung - Lung
Lung - Lung Cancer
Procedures - Procedures