Stapling cartridge lavage cytology in limited resection for pulmonary malignant tumors: assessment of cytological status of the surgical margin

INTRODUCTION: Sublobar resection in primary lung cancer and pulmonary metastatic tumor can result in recurrence at the surgical margin. Confirming the absence of tumor cells at the cut-end is important. We sought to evaluate the efficacy of intraoperative lavage cytology (ILC) of autostapling cartridges in preventing local failure. MATERIALS AND METHODS: An intraoperative cytology examination was performed in 262 consecutive patients undergoing wedge or segmental resection for 311 lesions, including primary lung cancers and pulmonary metastatic tumors, between April 2004 and April 2010. The data of patients with positive cytology results and those who developed local failure were retrospectively reviewed. RESULTS: A total of 139 primary lung cancers and 172 pulmonary metastatic tumors (primary site: 120 colorectal and 52 others) were investigated. The results revealed 22 (7%) positive cytology results (11 primary and 11 metastatic). The resection margins of 19 of the 22 lesions with positive cytology were additionally resected. With a median follow-up period of 42 months, recurrence at the margin developed in 2 of the 19 lesions in which additional resection was performed (11%, 1 primary and 1 metastatic). Recurrence at the margin developed in 2 (67%, 1 primary and 1 metastatic) of the 3 lesions in which additional resection was abandoned. Among the 289 lesions showing negative cytology results, recurrence at the margin developed in 7 (2%, 6 primary and 1 metastatic). CONCLUSIONS: ILC of autostapling cartridges in sublobar resection for pulmonary malignant tumor may be useful for assessing the cytological status of the surgical margin.