Choice of Surgical Procedure for Patients With Non–Small-Cell Lung Cancer ≤ 1 cm or &gt; 1 to 2 cm Among Lobectomy, Segmentectomy, and Wedge Resection: A Population-Based Study

Dai, Chenyang; Shen, Jianfei; Ren, Yijiu; Zhong, Shengyi; Zheng, Hui; He, Jiaxi; Xie, Dong; Fei, Ke; Liang, Wenhua; Jiang, Gening; Yang, Ping; Petersen, René Horsleben; Ng, Calvin S.H.; Liu, Chia Chuan; Rocco, Gaetano; Brunelli, Alessandro; Shen, Yaxing; Chen, Chang

doi:10.1200/jco.2015.64.6729

Cited by 221 publications

(172 citation statements)

References 21 publications

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“…However, segmentectomy typically involves less lymph nodes (LN) dissection than lobectomy, which may explain the higher recurrence observed in patients treated by this method. Recently, a population study indicated that lobectomy harbored a better survival than segmentectomy in NSCLC patients with tumors measuring ≤1 cm or 1 to 2 cm (12). Although several studies have shown a better survival benefit of lobectomy, only few have investigated the impact of extent of lymph node removal on the long-term outcome.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Qu¹,

Wang²,

Zhang³

et al. 2017

J. Thorac. Dis.

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Background: Segmentectomy has the advantage of less complications, but might have less lymph node sampling and higher risk of recurrence. We aimed to compare treatment outcome between two surgical options, and explore the effect of regional lymph node removal on the prognostic difference. Methods:We retrospectively analyzed data of stage I non-small cell lung cancer (NSCLC) (≤3 cm in size) patients who underwent either segmentectomy, or lobectomy, collected from the Surveillance, Epidemiology and End Results (SEER) database, from 2003 to 2013. The primary endpoints were overall survival (OS) and lung cancer-specific survival (LCSS). We also collected data from Shandong Provincial Hospital as validation.Results: Ultimately 1,156 patients treated by segmentectomy and 17,748 patients treated by lobectomy from SEER database were included in the analysis. Overall, segmentectomy was inferior to lobectomy in terms of OS [hazard ratio (HR): 1.316 (1.186-1.461), P<0.001] and LCSS [HR: 1.310 (1.142-1.504), P<0.001]. When the removal of regional lymph nodes (LN) was taken into consideration, no significant difference was found in OS and LCSS, in any Scope of Regional Lymph Node Surgery layer (0, 1-3, more than 3, and biopsy/sentinel layer, all P>0.05). After propensity score matching (PSM), there was no difference between segmentectomy and lobectomy in OS [HR: 1.081 (0.937-1.248), P=0.286] and LCSS [HR: 1.039 (0.861-1.253), P=0.692]. Only sex, age, histology, summary stage, differentiation, tumor size, and radiation still remained as independent prognostic factors for both OS and LCSS. For validation part, there was no significantly prognostic difference between lobectomy and sublobectomy group in overall (P=0.132) and each regional LN removed layer (0, 1-3, more than 3 layers: all P>0.05).Conclusions: Segmentectomy with proper lymph node resection or sampling could be a good alternative to lobectomy. IntroductionLung cancer is the leading cause of cancer-related death (26.5% of all) and has the second highest annual incidence in both males and females (13.3% for each), in the United States (1). More than half of lung cancer patients (57%) have distant metastasis at diagnosis, and overall 5-year relative survival rate is as low as 18% (1). Lung cancer can be divided into small cell lung cancer (SCLC, less than 20%) and non-small cell lung cancer (NSCLC, more than 80%), with entirely different treatment strategies and prognosis (2). Treatment strategies mainly include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy (2). Therein, approximately 69% of NSCLC patients with stages I and II are treated by surgery, compared to only 9% of patients with stages III and IV (2). Surgery is considered the best treatment option for early stage lung cancer, and anatomical lobectomy with N1 and at least three N2 stations sampling or dissection has become the standard surgery for early NSCLC patients (3). Minimally invasive video-assisted thoracoscopic lobectomy is also preferred for stage I NSCLC patients (4...

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Section: Introductionmentioning

confidence: 99%

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Qu¹,

Wang²,

Zhang³

et al. 2017

J. Thorac. Dis.

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“…A recent retrospective analysis of the results of limited resections compared to formal lobectomy in T1a NSCLC was performed by Dai et al (1). Based on their data, the authors concluded that lobectomy was superior to more limited resection for all tumors ≤2 cm.…”

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confidence: 99%

Limited resection versus lobectomy in early-stage non-small cell lung cancer

Toste¹,

Lee²

2016

J. Thorac. Dis.

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“…The reason for performing a uniportal segmentectomy for patients with an impaired lung function and/or a previous history of pulmonary resection or multiple pure GGO lesions with concurrent resection or a likelihood of having a second or even a third NSCLC resected in the future. However, in spite of controversy still remaining, most of them are good-risk suspected NSCLC patients with a diameter about 10 mm more or less or less proportion of solid component in our series (7,8). The preliminary data will be discussed in another recently submitted paper.…”

Section: Review Article On Thoracic Surgerymentioning

confidence: 78%

“…• Because most of these nodules, as you know, are present as more tiny, smaller, softer, deeper, invisible and impalpable, many VATS experts develop or design many different novel localization method (8,14), including but not limited to the following: ♦ Preoperative CT-guided hook-wire or microcoil or methylene blue staining; ♦ 3D CTA; ♦ Thoracoscopy exploration or in vivo finger palpation; ♦ DynaCT-guided (Hybrid OR); ♦ Mobile CT (O-arm); ♦ Intraoperative ultrasonography; ♦ Radio-guided localization; ♦ Magnetic navigational bronchoscopy.…”

Section: Spn Localizationmentioning

confidence: 99%

Uniportal video-assisted thoracoscopic anatomic segmentectomy for small-sized lung cancer

Wang

Sun

et al. 2016

J. Vis. Surg.

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Increasing evidences prove video-assisted thoracic surgery (VATS) segmentectomy is accepted as a valid alternative to lobectomy esp. a greater number of small lung nodules have been detected.Uniportal VATS segmentectomy for small-sized lung cancer is more challenging not only for technical issues in simple or complex uniportal segmentectomy, but also considering oncological efficacy in terms of localization, safe margin, the extent of lymph node dissection and pathological analysis. In this work, we evaluated our evolving uniportal experience, the surgical technique and decision-making of uniportal VATS segmentectomy for small-sized lung cancer.Keywords: Uniportal; video-assisted thoracic surgery (VATS); segmentectomy; lobectomy; lymph node dissection; localization; small-sized lung cancer Step Procedures already accomplished Jun 4-2016 1 Previous experience in anterior minthoracotomy (>1,000) and biportal lobectomy (>200) and biportal segmentectomy (>71) 2 Uniportal minor procedures (>300) 3 Uniportal lobectomy and segmentectomy (>500) 4 Uniportal for complex cases: segmentectomy 176 (from 2013 Aug 18 th ); sleeve lobectomy 2; sleeve segmentectomy 1; subsegmentectomy 3; segmentectomy with arterioplasty 3; lobectomy with arterioplasty 2; lobectomy with arterioplasty and bronchial reconstruction 1; pneumonectomy 3; central tumor 8; huge tumor >5 cm (6.1-7.0 cm) 9; severe adhesions 45; calcified lymph node 58; bilateral lobectomy 4; bilateral segmentectomy 5; bilobectomy 4; after chemotherapy 3; after TKI therapy 1; mediastinal tumor >50; LVRS >30; subxiphoid approach major resections 3; semisupine position for anterior mediastinal tumor and lobectomy with systematic lymphadectomy 1 5Non-intubated uniportal lobectomy/segmentectomy 18 (from 2015 Dec 31 to 2016 Mar 10)VATS, video-assisted thoracic surgery; LVRS, lung volume reduction surgery; TKI, tyrosine kinase inhibitor. Our uniportal VATS learning curve I evolve my uniportal approach from thoracoscopy-guided anterior minithoracotomy, then two incisions, not ever using the three or four incisions approach. Tables 1 and 2 s u m m a r i z e o u r l e a r n i n g c u r v e a n d a b u n d l e o f troubleshooting solutions to the major pitfalls frequently come across in uniportal VATS learning curve. We believe experienced uniportal lobectomy is a prerequisite for starting uniportal segmentectomy (4-6).Uniportal VATS segmentectomy for small-size lung cancer: patient selection and workup The indication was either a benign lesion or suspected metastasis in which wedge resection is not possible (42 patients), a suspicion of clinical stage I (≤2 cm in diameter) NSCLC (134 patients). The reason for performing a uniportal segmentectomy for patients with an impaired lung function and/or a previous history of pulmonary resection or multiple pure GGO lesions with concurrent resection or a likelihood of having a second or even a third NSCLC resected in the future. However, in spite of controversy still remaining, most of them are good-risk suspected NSCLC patients ...

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Choice of Surgical Procedure for Patients With Non–Small-Cell Lung Cancer ≤ 1 cm or > 1 to 2 cm Among Lobectomy, Segmentectomy, and Wedge Resection: A Population-Based Study

Cited by 221 publications

References 21 publications

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Limited resection versus lobectomy in early-stage non-small cell lung cancer

Uniportal video-assisted thoracoscopic anatomic segmentectomy for small-sized lung cancer

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