273. Do Pathologic Margins Matter in Anatomic Lung Resections?

*Stephen Yang, MD Invited Discussant
The Johns Hopkins Hospital
Baltimore, MD 
United States
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Stephen C. Yang, MD is Professor of Surgery and Medical Oncology, and the Arthur B. and Patricia B. Modell Endowed Chair in Thoracic Surgery at the Johns Hopkins Medical Institutions.  He is Vice-Chair of Professional Development for the Department of Surgery. His teaching, research and clinical service awards include: 1996 Johns Hopkins William F. Rienhoff Award for research; 1997 AATS Andrew Morrow Research Scholar; 2004 MCV Outstanding Alumnus Award; 2006 TSDA Socrates Award; 2006 STS J. Maxwell Chamberlain Award; 2008 Johns Hopkins Dean’s Award as Clinical Teacher of the Year; 2017 STSA Urschel-Mavroudis Spirit Award; 2018 Medical School Graduation Marshall; inductee of The Johns Hopkins Distinguished Teaching Society, AOA Honor Society at MCV, and ACS Academy of Master Surgeon Educators.

His clinical interests in general thoracic surgery, with emphasis in lung and esophageal cancer biology/survivorship, pectus repair, robotics surgery, geriatric thoracic surgery and enhancing the educational paradigm for medical students, residents and junior faculty.  He had developed novel techniques in lung transplantation with cadaveric lobar transplantation, and in robotic surgery.

Elected to the ABTS in 2014, he serves as Examination Chair and Editor-in-Chief of SESATS XIII and appointed to Chair the Council to develop Entrustable Professional Activities for CT surgery. He is President of the STSA, and immediate past Chair of the the Medical Student Education Committee for the ACS.  In 2019, he was elected to the ACGME RRC for Thoracic Surgery, and President-Elect of the TSDA.  He is the JTCVS Associate Editor for the education section.    

Though an empty nester now that his three children have flown the coop (and off the payroll!), he lives with his wife Marivic of 38 year in Hunt Valley, MD, and enjoys playing lounge piano music, country club tennis, “Chopped” cooking, taking care of his puppy Milo, and ballroom dancing, winner of the 2017 Dancing with the Hopkins Stars.

Kunaal Sarnaik Abstract Presenter
Case Western Reserve University School of Medicine
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Kunaal Sarnaik is a rising third-year medical student at Case Western Reserve University School of Medicine. His clinical research in the cardiothoracic domain primarily lies in computational analysis of clinical outcomes and risk model generation. 

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


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.

Presentation Duration

7 minute presentation; 7 minute discussion 

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