Anatomical Segmentectomy and Wedge Resections Are Associated with Comparable Outcomes for Patients with Small cT1N0 Non–Small Cell Lung Cancer

Altorki, Nasser K.; Kamel, Mohamed; Narula, Navneet; Ghaly, Galal; Nasar, Abu; Rahouma, Mohamed; Lee, Paul C.; Port, J. L.; Stiles, Brendon M.

doi:10.1016/j.jtho.2016.06.031

Cited by 115 publications

(86 citation statements)

References 18 publications

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“…Our cohort included 3 groups: (I) bony sarcomas as osteosarcomas, chondrosarcomas, and primitive neuroectodermal tumor (PNET)/Ewing's sarcoma; (II) soft tissue sarcoma as fibromatosis/fibrosarcoma, pleomorphic undifferentiated sarcoma previously named malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, synovial sarcoma, angiosarcoma, myxofibrosarcoma, rhabdomyosarcoma , myxoliposarcoma; (III) others as carcinomas, solitary plasma cell myeloma and lymphoma that were initially diagnosed as liposarcoma (9)(10)(11)(12).…”

Section: Patients and Data Collectionmentioning

confidence: 99%

“…Overall survival (OS) is the time from date of surgery to date of death from cancer or other causes or date of last follow-up, while disease free survival (DFS) is the time from date of surgery to date of first recurrence, death from cancer or other causes or the date of last follow-up (12). Median follow-up was 36 months [interquartile range (IQR) =11.5-60] for the whole group.…”

Section: Survival and Follow-up Datamentioning

confidence: 99%

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Contributing factors to the outcome of primary malignant chest wall tumors

et al. 2017

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Background: Primary malignant chest-wall tumors (PMCWTs) are a heterogeneous group of tumors.They require a special experience in designing resection and reconstruction. They account for less than 1% of all primary malignant tumors. This study is designed to clarify different factors contributing to the outcome of patients with PMCWTs in our institution. Methods: A retrospective study included 98 patients with pathology proven PMCWTs, treated at the National Cancer Institute (NCI), Cairo University, Egypt, during the past 10 years.

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Section: Patients and Data Collectionmentioning

confidence: 99%

Section: Survival and Follow-up Datamentioning

confidence: 99%

Contributing factors to the outcome of primary malignant chest wall tumors

et al. 2017

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“…[3,4] In cases of pulmonary wedge resection of lung cancer, malignant positive margin detected by cytology is an indicator of recurrence and poor survival, [6] while attaining a malignant-negative margin of pulmonary wedge lung cancer resection is speculated to be an indicator of good prognosis. Altorki et al [27] reported a prognosis of pulmonary wedge lung cancer resection similar to that of segmentectomy when a wedge resection was carried out with sufficient margin distance and malignantnegative surgical margin.…”

Section: Discussionmentioning

confidence: 96%

Lung cancer biopsy dislodges tumor cells into circulating blood

Sawabata¹,

Kitamura²,

Nitta³

et al. 2017

JCMT

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Aim:A "seed" of lung cancer metastasis is circulating tumor cells (CTCs), which may be dislodged from a tumor during biopsy. This possibility was assessed among patients who underwent lung tumor biopsy using flexible fiber-topic bronchoscopy (FFB). Methods: The study involved six patients with non-small cell lung cancer who underwent FFB biopsy to diagnose a lesion pathologically (5 males and 1 female, median age 63 years, 6 adenocarcinomas, of 4 clinical-stage IA, 1 stage IB, and 1 stage IIIA), CTCs were extracted from the peripheral vein blood at pre-FFB and at post-FFB using a size selection method. Results: No tumor cell was detected at pre-and post-FFB was in three cases (50%); no tumor cells were detected pre-FFB while CTCs were detected at post-FFB in two cases (33.3%); and CTCs were detected at pre-FFB with numerous CTCs detected at post-FFB in one case (17.7%). In addition, similar tendencies were observed in each analysis of singlecell and clustered-cell categories. Conclusion: These results suggest that a FFB biopsy of lung cancer may potentially dislodge CTCs from a tumor into the circulating peripheral blood. Key words:Lung cancer, biopsy, circulating tumor cells ABSTRACTArticle history:

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“…Thus, for benign lesions or metastasis, wedge non-anatomical resections were first attempted as they were more simple procedures. Recent advances in the knowledge of lung cancer surgery showed that anatomical segmentectomies have its role in lung cancer treatment because of its comparable outcomes in terms of recurrence and survival, which are similar to lobectomy for early stage adenocarcinoma without nodal involvement (3,4). Asian surgeons face more often these pattern of lung adenocarcinoma with slow growth so in those countries anatomical segmentectomies have developed interestingly, improving the knowledge and comprehension about intralobar anatomy and technical aspects of sublobar procedures such as segmentectomies and subsegmentectomies (5).…”

Section: Discussionmentioning

confidence: 99%

Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8)

Gálvez¹,

Lirio²,

Sesma³

et al. 2017

J. Vis. Surg.

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Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months. (Figure 2A). Just below the arterial stump, we dissected the bronchus. After initial dissection of both the S8 and the S9+10 segmental bronchus, we individualized the S8 bronchus and, as usual, we made an intraoperative fiberbronchoscopy for guidance and, clamping the segmental bronchus, we checked the bronchoscope light through the bronchial wall proximal to the clamp ( Figure 2B). After careful identification of the segmental vein V8, we divided the fissure between S8 and S9+10 with thick load staplers. Then we checked that the segmental vein V6 and V9+10 were preserved and we divided the V8 by using a vascular stapler ( Figure 2C). Last step to complete the segmentectomy requires division of the parenchyma between S8 and the surrounding segments (S6 and S9+10), and needs a thorough revision for avoiding unnoticed division of V9+10 or V6 with the parenchyma staplers. Total operating time was 140 minutes ( Figure 3).After 24 hours in the Intermediate Care Unit, chest tube was removed without air leak and normal lung reexpansion, and the patient was discharged home on the 5 th postoperative day mainly due to patient's frighten to be discharged sooner after a pulmonary resection. Visual analogue scale (VAS) scores were 3/10 and 3/10 on POD 1 and 2.Final pathological exam showed a 3 cm sclerosant pneumocytoma without mitosis. Chest X-ray one month after the surgery showed an uneventful LLL reexpansion. DiscussionFor many years, anatomical lobectomies and more extensive procedures (bilobectomies and pneumonectomies) were the most common anatomical resections due to better oncologic outcomes for lung cancer surgery (2). Thus, for benign lesions or metastasis, wedge non-anatomical resections were first attempted as they were more simple procedures. Recent advances in the knowledge of lung cancer surgery showed that anatomical segmentectomies have its role in lung cancer treatment because of its comparable outcomes in terms of recurrence and survival, which are si...

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Anatomical Segmentectomy and Wedge Resections Are Associated with Comparable Outcomes for Patients with Small cT1N0 Non–Small Cell Lung Cancer

Abstract: Our data show that WR and AS are comparable oncologic procedures for carefully staged cT1N0 NSCLC patients. Although AS is associated with a more thorough lymph node dissection, this did not translate to a survival benefit in this patient population with a low rate of nodal metastases.

Cited by 115 publications

References 18 publications

Contributing factors to the outcome of primary malignant chest wall tumors

Contributing factors to the outcome of primary malignant chest wall tumors

Lung cancer biopsy dislodges tumor cells into circulating blood

Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8)

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