Comparison of surgical outcomes and prognosis between wedge resection and simple Segmentectomy for GGO diameter between 2 cm and 3 cm in non-small cell lung cancer: a multicenter and propensity score matching analysis

Abstract

Background As segmentectomy had become commonly used for Non-Small Cell Lung Cancer (NSCLC) treatment, which had the advantages of radical operation, however, it remains controversial owing to procedural complexity and risk of increased complications compared with wedge resection. We evaluated operative and postoperative outcomes of simple segmentectomy compared to wedge resection in ground-glass opacity (GGO) diameter between 2 cm and 3 cm NSCLC. Methods We retrospectively reviewed 1600 clinical GGO diameter between 2 cm and 3 cm NSCLC patients who received simple segmentectomy and wedge resection between Jan 2011 and Jan 2015. Participants were matched 1:1 on their propensity score for two groups. Clinic-pathologic, operative, and postoperative results of two groups were compared. Results After using propensity score methods to create a matched cohort of participants with simple segmentectomy group similar to that wedge resection, there were no significant differences detected in tumor size, margin distance, histology, age, sex, preoperative comorbidities and preoperative pulmonary function. Overall complications in simple segmentectomy group were more than wedge resection group (21% vs 3%, p = 0.03). Median operative time (110.6 vs. 71.2 min; p = 0.01) and prolonged air leakage (12% vs. 3%; p = 0.02) was significantly longer in the simple segmentectomy group. There was no difference in recurrence free survival (RFS) and overall survival (OS) of 5-years between simple segmentectomy group and wedge resection group. Postoperative pulmonary function in simple segmentectomy group recovered more slowly than wedge resection group. Conclusion Wedge resection may have comparable efficacy as simple segmentectomy for GGO diameter between 2 cm and 3 cm NSCLC, but lead to less complications, less surgical procedure and faster recovery of pulmonary function.

Risk factors for postoperative cerebral infarction in patients after lung resection: a single-center case-control study

“…Our study also demonstrated that postoperative cerebral infarction was more frequent with segmentectomy than with wedge resection (OR, 3.478; 95% CI, 0.995-12.163; P=0.051), although this difference did not retain statistical significance in the multivariate logistic regression analysis. This finding is somewhat consistent with previous studies that have found higher rates of complications with segmentectomy (13)(14)(15).…”

Wedge resection vs. segmentectomy for lung cancer measuring ≤ 2 cm with consolidation tumor ratio > 0.25

“…compared the prognosis of 100 paired patients with NSCLC who underwent simple segmentectomy and wedge resection for tumor size 2–3 cm with a solid component less than 2 cm in size using PSM analysis. They reported comparable OS between the two surgical procedures ( 11 ). Cao et al.…”

“…Due to the longer operative time ( 9 – 11 ), increased blood loss ( 9 , 11 ), and higher frequency of postoperative complications ( 9 , 10 , 12 , 13 ), segmentectomy is a more invasive procedure than wedge resection for patients with lung cancer. Furthermore, segmentectomy is more technically challenging than wedge resection and requires a greater level of surgical expertise ( 9 ).…”

“…Furthermore, segmentectomy is more technically challenging than wedge resection and requires a greater level of surgical expertise ( 9 ). However, wedge resection has been reported to have smaller tumor margins than segmentectomy ( 9 , 10 , 12 , 14 ) and there is a difficulty in dissecting lymph nodes, especially in the hilar region ( 9 , 11 – 13 ). There is concern that wedge resection may be less curative for tumors than segmentectomy ( 10 , 15 , 16 ).…”

Comparison of two methods for CT-guided pulmonary nodule location before thoracoscopic surgery.

“…Preoperative localization techniques can be used to quickly find pulmonary nodules that are difficult to locate under VATS. Simultaneously, sublobar resection was performed with accurate localization, and the minimum extent of pulmonary nodules was removed to avoid excessive resection of normal lung tissue and maximize the protection of lung function [ 12 , 13 ]. As presented in our clinical work, a ground-glass nodule in the upper lobe of the right lung was seen in a middle-aged woman, in whom the VATS was performed directly without preoperative location of the nodule.…”