Ernest Chan - Academia.edu (original) (raw)
Papers by Ernest Chan
Chest
PURPOSE: Anatomic segmentectomy has emerged as an effective alternative to lobectomy for patients... more PURPOSE: Anatomic segmentectomy has emerged as an effective alternative to lobectomy for patients with small (# 2 cm) clinical stage I non-small cell lung cancers. Little is known about the efficacy of anatomic segmentectomy in the setting of N1 disease, which is traditionally treated with lobectomy. The purpose of the study is to determine the outcomes of anatomic segmentectomy vs. lobectomy in patients with pathological N1 disease. METHODS: Patients undergoing anatomic segmentectomy (n=21) and lobectomy (n=72) for histologically-proven N1 non-small cell lung cell lung cancer were identified from a prospectively maintained single-institution database. Primary outcomes included mortality, length of hospital stay, readmission rates as well as recurrence-free and overall survival. Comparisons were performed with Student's t-test and X 2 test. Recurrence-free and overall survival were analyzed by the Kaplan-Meier method. RESULTS: Age, gender and preoperative co-morbidities including hypertension, coronary artery disease, COPD, diabetes mellitus, reflux disease and prior cancers were similar between groups. Patients undergoing lobectomy had significantly larger tumors compared to patients undergoing segmentectomy (3.8cm vs. 2.6cm, respectively, p=.034) with a higher number of nodes sampled (19.4 vs. 9.0, p<.01). Overall peri-operative mortality (1.4% vs. 0%, p=.59), length of stay (8.1 days vs. 9.6 days, p=.68), re-admission within 30 days (11% vs. 19%, p=.69) were similar between lobectomy and segmentectomy, respectively. Locoregional (15 vs. 19%, p=.22) and distant metastasis (17 vs. 14%, p=.79) were also not significantly different. Recurrence-free survival was longer in lobectomy patients; however, this was not statistically significant (97.6 months vs. 65.7 months, p=.364). Overall survival was significantly greater for lobectomy compared with segmentectomy (median 89.8 months vs. 49.0 months, p=0.001). CONCLUSIONS: Anatomic segmentectomy was associated with similar peri-operative outcomes and recurrence risk compared to lobectomy in the setting of pathological N1 disease. Lobectomy was associated with improved overall survival. CLINICAL IMPLICATIONS: Lobectomy does not appear to be associated with reduced recurrence risk, but is associated with greater overall survival in patients with N1 non-small cell lung cancers. Therefore, lobectomy should remain standard of care when N1 disease is present. However, given similar recurrence risks, anatomic segmentectomy may by feasible in patients who cannot undergo lobectomy.
Chest
PURPOSE: Anatomic segmentectomy has emerged as an effective alternative to lobectomy for patients... more PURPOSE: Anatomic segmentectomy has emerged as an effective alternative to lobectomy for patients with small (# 2 cm) clinical stage I non-small cell lung cancers. Little is known about the efficacy of anatomic segmentectomy in the setting of N1 disease, which is traditionally treated with lobectomy. The purpose of the study is to determine the outcomes of anatomic segmentectomy vs. lobectomy in patients with pathological N1 disease. METHODS: Patients undergoing anatomic segmentectomy (n=21) and lobectomy (n=72) for histologically-proven N1 non-small cell lung cell lung cancer were identified from a prospectively maintained single-institution database. Primary outcomes included mortality, length of hospital stay, readmission rates as well as recurrence-free and overall survival. Comparisons were performed with Student's t-test and X 2 test. Recurrence-free and overall survival were analyzed by the Kaplan-Meier method. RESULTS: Age, gender and preoperative co-morbidities including hypertension, coronary artery disease, COPD, diabetes mellitus, reflux disease and prior cancers were similar between groups. Patients undergoing lobectomy had significantly larger tumors compared to patients undergoing segmentectomy (3.8cm vs. 2.6cm, respectively, p=.034) with a higher number of nodes sampled (19.4 vs. 9.0, p<.01). Overall peri-operative mortality (1.4% vs. 0%, p=.59), length of stay (8.1 days vs. 9.6 days, p=.68), re-admission within 30 days (11% vs. 19%, p=.69) were similar between lobectomy and segmentectomy, respectively. Locoregional (15 vs. 19%, p=.22) and distant metastasis (17 vs. 14%, p=.79) were also not significantly different. Recurrence-free survival was longer in lobectomy patients; however, this was not statistically significant (97.6 months vs. 65.7 months, p=.364). Overall survival was significantly greater for lobectomy compared with segmentectomy (median 89.8 months vs. 49.0 months, p=0.001). CONCLUSIONS: Anatomic segmentectomy was associated with similar peri-operative outcomes and recurrence risk compared to lobectomy in the setting of pathological N1 disease. Lobectomy was associated with improved overall survival. CLINICAL IMPLICATIONS: Lobectomy does not appear to be associated with reduced recurrence risk, but is associated with greater overall survival in patients with N1 non-small cell lung cancers. Therefore, lobectomy should remain standard of care when N1 disease is present. However, given similar recurrence risks, anatomic segmentectomy may by feasible in patients who cannot undergo lobectomy.