Minimally Invasive Lobectomy Is Associated With Lower Noncancer-specific Mortality in Elderly Patients

Hristov, Boris; Eguchi, Takashi; Bains, Sarina; Dycoco, Joseph; Tan, Kay See; Isbell, James M.; Park, Bernard J.; Jones, David R.; Adusumilli, Prasad S.

doi:10.1097/sla.0000000000002772

Cited by 26 publications

(13 citation statements)

References 38 publications

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“…In our study, tumor size was also associated with a higher risk of decreased OS and CSS upon multivariate analysis. Nowadays, lobectomy has been recommended as the standard surgical procedure for operable NSCLC ( 3 , 24 ), especially for tumors larger than 2 cm ( 25 – 27 ). Based on our data, lobectomy should be considered as the first choice for NSCLC > 5 to 7 cm which was congruent with the current guidelines.…”

Section: Discussionmentioning

confidence: 99%

Choice of Treatment for Patients With Non–small-cell Lung Cancer >5 cm Between Surgery Alone and Surgery Plus Adjuvant Radiotherapy

et al. 2021

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Background: According to the lung cancer staging project, T2b (>5–7 cm) and T3 (>7 cm) non-small cell lung cancers (NSCLC) should be reclassified into T3 and T4 groups. The objective of this study was to evaluate the effect of surgery alone or surgery plus adjuvant radiation (SART) on survival of node-negative patients with NSCLC >5 cm.Methods: We identified 4557 N0 patients with NSCLC >5 cm in the Surveillance, Epidemiology, and End Results database from 2004 to 2014. Overall survival (OS) and cancer–specific survival (CSS) were compared among patients who underwent surgery alone and SART. The proportional hazards model was applied to evaluate multiple prognostic factors.Results: 1,042 and 525 patients who underwent surgery alone and SART, respectively were enrolled after propensity-score matching. OS and CSS favored surgery alone rather than SART. Multivariate analysis showed that the number of lymph nodes examined more than six was associated with better OS and CSS for NSCLC >5 cm, especially in patients treated with surgery alone. Lobectomy should be recommended as the primary option for NSCLC >5 to 7 cm, whereas its superiority was not significant over sublobectomy for NSCLC >7 cm.Conclusion: Surgery alone should be recommended as the first choice for patients with NSCLC >5 cm. The number of examined lymph nodes should be more than six in patients with NSCLC >5 cm, especially for those who undergo surgery alone. For patients with NSCLC >7 cm who could not tolerate lobectomy, sublobectomy might be an alternative surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Choice of Treatment for Patients With Non–small-cell Lung Cancer >5 cm Between Surgery Alone and Surgery Plus Adjuvant Radiotherapy

et al. 2021

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“…Past research on cause-specific mortality following lobectomy for early-stage lung cancer has revealed a higher incidence of non-cancer-related deaths compared to lung cancer-related deaths up to 1.5 years post-surgery in elderly patients [ 1 ]. Moreover, early-phase non-cancer-specific death was strongly associated with severe postoperative morbidity [ 1 , 2 ]. A large prospective randomized trial (JCOG0802/WJOG4607L) comparing segmentectomy and lobectomy outcomes for small lung cancers found a higher occurrence of deaths from respiratory disease, cerebrovascular disease, and cancers other than lung cancer in the lobectomy group compared to that in the segmentectomy group [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Predicting 1-year non-cancer-related adverse events after lung resection

Eguchi,

Ide,

Matsuoka

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES Assessing the risk for non-cancer-related outcomes following lung cancer surgery is crucial for high-risk patients. This study examined non-cancer-related adverse events within 1 year after lung resection, emphasizing the role of resected lung volume and postoperative atrial fibrillation (POAF). METHODS We conducted a retrospective analysis of 460 patients who underwent anatomical lung resection for malignant lung tumours. We assessed perioperative factors, such as the number of resected subsegments and POAF, as potential predictors of 1-year non-cancer-related adverse events. Additionally, we validated a previously published nomogram for predicting POAF. RESULTS One-year non-cancer-related adverse events occurred in 20% of patients. Multivariable analysis identified higher age, lower percentage-predicted forced expiratory volume in 1 second, greater number of resected subsegments and POAF as independent predictors of these adverse events. The incidence of POAF was 8.5%, with higher age, history of atrial fibrillation, and open thoracotomy as independent predictors. A temporal link between POAF and other severe postoperative complications was observed, as 71% of POAF cases preceded other complications. The nomogram's predicted risk for POAF was associated well with the actual incidence. CONCLUSIONS Resected lung volume and POAF are statistically significant factors associated with non-cancer-related outcomes after lung resection. Minimizing resected lung volume when oncologically and technically feasible, along with identifying patients at risk for POAF, may contribute to improved postoperative outcomes. Our results have implications for risk stratification and preoperative decision-making in lung cancer surgery.

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“…The use of thoracic minimally invasive surgery (MIS), including video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS), has increased with the growing evidence of improved outcomes, such as postoperative pain, quality of life, complications, and non-cancer-related mortality [7][8][9][10]. A recent study using the United States national database demonstrated that the use of MIS segmentectomy has been increasing without compromising oncologic outcomes, compared with the open approach for clinical stage IA lung cancer [11].…”

Section: Introductionmentioning

confidence: 99%

Technical Advances in Segmentectomy for Lung Cancer: A Minimally Invasive Strategy for Deep, Small, and Impalpable Tumors

Eguchi

Satô

Shimizu

2021

Cancers

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With the increased detection of early-stage lung cancer and the technical advancement of minimally invasive surgery (MIS) in the field of thoracic surgery, lung segmentectomy using MIS, including video- and robot-assisted thoracic surgery, has been widely adopted. However, lung segmentectomy can be technically challenging for thoracic surgeons due to (1) complex segmental and subsegmental anatomy with frequent anomalies, and (2) difficulty in localizing deep, small, and impalpable tumors, leading to difficulty in obtaining adequate margins. In this review, we summarize the published evidence and discuss key issues related to MIS segmentectomy, focusing on preoperative planning/simulation and intraoperative tumor localization. We also demonstrate two of our techniques: (1) three-dimensional computed tomography (3DCT)-based resection planning using a novel 3DCT processing software, and (2) tumor localization using a novel radiofrequency identification technology.

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Minimally Invasive Lobectomy Is Associated With Lower Noncancer-specific Mortality in Elderly Patients

Abstract: In a propensity score-matched cohort, multivariable analysis has indicated that lobectomy performed by MIS is associated with lower incidence of noncancer-specific mortality compared with lobectomy performed by open thoracotomy in elderly patients with NSCLC.

Cited by 26 publications

References 38 publications

Choice of Treatment for Patients With Non–small-cell Lung Cancer >5 cm Between Surgery Alone and Surgery Plus Adjuvant Radiotherapy

Choice of Treatment for Patients With Non–small-cell Lung Cancer >5 cm Between Surgery Alone and Surgery Plus Adjuvant Radiotherapy

Predicting 1-year non-cancer-related adverse events after lung resection

Technical Advances in Segmentectomy for Lung Cancer: A Minimally Invasive Strategy for Deep, Small, and Impalpable Tumors

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