Anatomic Segmentectomy in the Treatment of Stage I Non-Small Cell Lung Cancer (original) (raw)
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Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma
Annals of cardiothoracic surgery, 2014
Despite the increasing prevalence of the early discovery of small-sized non-small cell lung cancers (NSCLCs), particularly adenocarcinoma, sublobar resection has not yet gained acceptance for patients who can tolerate lobectomy. We compared the outcomes of segmentectomy (n=155) and lobectomy (n=479) in 634 consecutive patients with clinical stage IA lung adenocarcinoma and in propensity score-matched pairs. Those who had undergone wedge resection were excluded. The 30-day postoperative mortality rate in this population was zero. Patients with large or right-sided tumors, high maximum standardized uptake value (SUVmax), pathologically invasive tumors (with lymphatic, vascular, or pleural invasion), and lymph node metastasis underwent lobectomy significantly more often. Three-year recurrence-free survival (RFS) was significantly higher after segmentectomy compared to lobectomy (92.7% vs. 86.9%, P=0.0394), whereas three-year overall survival (OS) did not significantly differ (95.7% vs....
Lung Segmentectomy in NSCLC Surgery
Life
Current guidelines recommend surgery for early-stage non-small cell lung cancer (NSCLC). The standard treatment for patients with cT1N0 NSCLC has been lobectomy with lymph-node dissection, with sublobar resection used only in patients with inadequate cardio-respiratory reserve, with poor performance status, or who are elderly. In 1995, the Lung Cancer Study Group published the results of a randomized, prospective trial demonstrating the superiority of lobectomy compared with sublobar resection. From then on, wedge resection and segmentectomy were reserved exclusively for patients with poor functional reserve who could not tolerate lobectomy. Therefore, the exact role of segmentectomy has been controversial over the past 20 years. Recently, the randomized controlled trial JCOG0802/WJOG4607L demonstrated that segmentectomy was superior to lobectomy in patients with stage IA NSCLC (<2 cm and CTR < 0.5) in terms of both overall-survival and post-operative lung function. Based on t...
The Annals of thoracic surgery, 2015
We retrospectively compared the oncologic outcome after segmentectomy versus lobectomy in patients with clinical (c-) T1a N0 M0 non-small cell lung cancer (NSCLC) detected as a part-solid ground-glass nodule or purely solid nodule on thin-section computed tomography. From 1997 to 2010, 312 patients with c-T1a N0 M0 NSCLC were determined to require a surgical approach categorized as segmentectomy or lobectomy. Preoperatively available data were collected using logistic regression analysis, and propensity matching was performed. Factors affecting local-regional recurrence were assessed by Cox proportional hazards regression analysis and Kaplan-Meier estimates. The 5-year and 10-year overall survival rates for the 80 patients who underwent segmentectomy were 97.5% and 83.5%, respectively, compared with 87.75% and 75.0%, respectively, for the 232 patients who underwent lobectomy (p = 0.019). Local-regional recurrence as the first relapse site was found in 3 the 80 segmentectomies (3.8%)...
Segmentectomy vs Lobectomy for Pathological N1 Non-Small Cell Lung Cancer
Chest
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.
The Journal of Thoracic and Cardiovascular Surgery, 2013
Objective: Our objective was to compare the oncologic outcomes of lobectomy and segmentectomy for clinical stage IA lung adenocarcinoma. Methods: We examined 481 of 618 consecutive patients with clinical stage IA lung adenocarcinoma who underwent lobectomy or segmentectomy after preoperative high-resolution computed tomography and F-18-fluorodeoxyglucose positron emission tomography/computed tomography. Patients (n ¼ 137) who underwent wedge resection were excluded. Lobectomy (n ¼ 383) and segmentectomy (n ¼ 98) as well as surgical results were analyzed for all patients and their propensity score-matched pairs. Results: Recurrence-free survival (RFS) and overall survival (OS) were not significantly different between patients undergoing lobectomy (3-year RFS, 87.3%; 3-year OS, 94.1%) and segmentectomy (3-year RFS, 91.4%; hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.27-1.20; P ¼ .14; 3-year OS, 96.9%; HR, 0.49; 95% CI, 0.17-1.38; P ¼ .18). Significant differences in clinical factors such as solid tumor size (P<.001), maximum standardized uptake value (SUVmax) (P <.001), and tumor location (side, P ¼ .005; lobe, P ¼ .001) were observed between both treatment groups. In 81 propensity score-matched pairs including variables such as age, gender, solid tumor size, SUVmax, side, and lobe, RFS and OS were similar between patients undergoing lobectomy (3-year RFS, 92.9%, 3-year OS, 93.2%) and segmentectomy (3-year RFS, 90.9%; 3-year OS, 95.7%). Conclusions: Segmentectomy is suitable for clinical stage IA lung adenocarcinoma, with survivals equivalent to those of standard lobectomy.
Oncologic Outcomes After Surgical Resection of Subcentimeter Non-Small Cell Lung Cancer
The Annals of Thoracic Surgery, 2011
Background. The recent initiation of screening protocols and greater utilization of computed tomography has led to an increasing proportion of non-small cell lung cancer (NSCLC) patients presenting with subcentimeter stage IA tumors. The aim of this study was to compare the oncologic outcomes of lobectomy, segmentectomy, and wedge resection in patients with NSCLC tumors 1 cm or less in diameter.
Comparison of Extended Segmentectomy with Traditional Segmentectomy for Stage I Lung Cancer
2021
Background For stage I non-small cell lung cancer (NSCLC), lobectomy and segmentectomy are still controversial operations. Extended segmentectomy was proposed to make larger safe margins than segmentectomy. Image-guided video-assisted thoracoscopic surgery (iVATS) is useful to accomplish extended segmentectomy. We aimed to compare the effects of iVATS extended segmentectomy to the effects of traditional segmentectomy for stage I NSCLC. Methods This study is a retrospective analysis in a single institute. Patients with stage I NSCLC who received segmentectomy between January 2017 and September 2020 were included. Patients were distributed to iVATS extended segmentectomy (group A), and traditional segmentectomy (group B). The impacts of the different surgical methods on resection margin were assessed. Results There were 116 patients enrolled in this study. Sixty-two patients distributed in group A, and the other 54 patients in group B. The resection margin to a staple line was 17.94 m...