Lobectomy Versus Segmentectomy in Radiologically Pure Solid Small-Sized Non-Small Cell Lung Cancer

Koike, Terumoto; Kitahara, Akihiko; Sato, Seijiro; Hashimoto, Takehisa; Aoki, Tadashi; Koike, Teruaki; Yoshiya, Katsuo; Toyabe, Shin-ichi; Tsuchida, Masanori

doi:10.1016/j.athoracsur.2015.10.048

Cited by 64 publications

(60 citation statements)

References 27 publications

(41 reference statements)

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“…In the current study, the 5-year RFS was 95.5% with a GGO-predominant tumor and 64.9% with a solid-predominant tumor. This result was similar to other studies (6,9). For GGOpredominant tumors, most patients underwent an elective sublobar resection because of a strong probability for a good postoperative prognosis.…”

Section: Discussionsupporting

confidence: 81%

“…Until now, it has been difficult to establish guidelines for sublobar resection in radiologically solid-predominant lung cancer because of a lack of sufficient homogenous data (8). However, some studies reported that survival after sublobar resection for small-sized (≤2 cm) NSCLC is similar to that of lobectomy (9). Further, randomized trials including lung cancer with solid features are currently ongoing to validate these conclusions (CALGB 140503, JCOG 0802) (10,11).…”

Section: Original Articlementioning

confidence: 98%

“…However, in some studies, patients who underwent sublobar resection demonstrated comparable outcomes with anatomical lobectomy for early-stage lung cancer (8,9). Sublobar resection has remained controversial, and two randomized controlled trials are ongoing (CALGB 140503, JCOG 0802).…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

et al. 2016

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Background: Sublobar resection is considered controversial for non-small cell lung cancer (NSCLC) presenting as a solid-predominant nodule. The aim of this study was to identify risk factors related to recurrence in small-sized NSCLC presenting as a solid-predominant nodule. Methods: We conducted a retrospective chart review of 118 patients who were treated for clinical N0 NSCLC sized ≤2 cm and who underwent sublobar resection with clear resection margins. We assigned them to two groups according to radiologic features: ground glass opacity (GGO)-predominant tumor and solidpredominant tumor. Clinicopathological characteristics and survival were analyzed in both groups. Risk factors for recurrence were analyzed in the solid-predominant tumor group. Results: Seventy-three patients had a GGO-predominant tumor, and 45 patients had a solid-predominant tumor. Five-year recurrence-free survival (RFS) in the solid-predominant tumor and GGO-predominant tumor groups was 64.9% and 95.5%, respectively. A multivariate analysis was performed to determine factors associated with recurrence after sublobar resection in the solid-predominant tumor group; it indicated that SUVmax [hazard ratio (HR) =1.482, 95% confidence interval (CI): 1.123-1.956, P=0.005] and histologic types other than adenocarcinoma (squamous cell carcinoma, HR =8.789, 95% CI: 1.572-49.134, P=0.013; other types, HR =53.569, 95% CI: 2.616-1096.849, P=0.010) were significant risk factors for recurrence.Conclusions: Risk factors in solid-predominant tumors sized ≤2 cm after sublobar resection are a high SUVmax and histologic types other than adenocarcinoma. Thus, lobectomy should be considered for solidpredominant NSCLC sized ≤2 cm with a high SUVmax or non-adenocarcinoma types.

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Section: Discussionsupporting

confidence: 81%

Section: Original Articlementioning

confidence: 98%

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Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

et al. 2016

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“…Adenokarsinomda lobektomi wedge rezeksiyondan üstündür ancak segmentektomi ile eş değer sonuçlar açıklanmaktadır (16,17). Adenokarsinom alt tiplerinde sağkalım ve nüks özellikleri farklılık göstermektedir.…”

Section: Evre 1 Ve 2 Küçük Hücre Dışı Akciğer Kanserinde Tedaviunclassified

Treatment Approaches in Lung Cancer

Yılmaz¹

2018

Nts

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Akciğer kanseri tüm Dünya'da kansere bağlı ölümlerin önde gelen nedenidir (1,2). Akciğer kanserlerinde tedavi kararı başlıca tümör histolojisi, hastalığın evresi ve yaş, pulmoner fonksiyonlar ve ko-morbiditeler gibi hasta ile ilişkili spesifik özellikler doğrultusunda verilir. Tedavi seçeneklerini belirlemek, prognozu ön görebilmek için en önemli aşama evrelemedir. Tanısal yöntemlerle ayrıntılı bir evreleme yapılmasına rağmen klinik evre ve patolojik evre uyumu %50-60 olarak bildirilmektedir (3,4). Küçük hücre dışı akciğer kanserinde (KHDAK) 5 yıllık sağkalım %18'dir, evre 1 ve 2, anatomik rezeksiyon uygulanan olgularda ise sağkalım %60-80 olmaktadır (5). Lokalize, evre 1 ve evre 2 hastalık tüm KHDAK'nin %30'unu oluşturmaktadır.Medikal olarak cerrahiye uygun, mediyasten invazyonu olmayan non metastatik evre 1 ve 2 hastalarda standart tedavi yaklaşımı; cerrahidir (5,6).Bölgesel tedavi planlanan tüm hastalarda operasyon öncesi kardiyopulmoner risk değerlendirilmelidir (7). Hastanın kardiyopulmoner yeterliliği değerlendirildikten sonra risk spesifik modeller ile operasyon sonrası mortalite ve morbidite belirlenmelidir. Özellikle 65 yaş üzeri hastalar yaş ve yaşam stili ile ilgili çok sayıda komorbiditeye sahip olabilir. Akciğer kanserine yönelik tedavi yaklaşımları pulmoner ve vasküler rezervde azalmaya neden olacaktır, bu nedenle tedavi öncesi dikkatli bir değerlendirme gereklidir (Şekil 1). Cerrahi adayı hastalarda operasyon sonrası mortalite ve morbidite, operasyon öncesi birinci saniyede zorlu ekspiratuvar volüm (FEV1) ve karbonmonoksit difüzyon kapasitesi düzeyleri ile öngörülebilir (8 Öz AbstractAkciğer kanseri kadınlarda ve erkeklerde tüm Dünya'da kansere bağlı ölümlerin ilk sıra nedenidir. Her yıl 1.8 milyon yeni akciğer kanseri tanısı konmakta, bu nedenle 1.6 milyon ölüm bildirilmektedir. Akciğer kanserli hastaların halen büyük bir bölümünün ileri evrede tanı almasına rağmen erken tanıya yönelik yüksek riskli hastalarda tarama modelleri ve yeni tanı yöntemleri geliştirilmiş, yine bu doğrultuda cerrahi ve geleneksel cerrahiye uygun olmayan hastalara yönelik tedavi modelleri geliştirilmiştir. Hastalığın tedavisi hücre türüne, tümörün evresine, moleküler özelliklerine, hastanın genel medikal durumuna göre planlanmaktadır.

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“…Lobectomy combined with systematic lymph node (LN) dissection or sampling currently is the treatment of choice for patients with NSCLC. However, increasing evidence has emerged from institutional case series and national registry to Original Article Appropriate lymphadenectomy significantly reduced recurrence after segmentectomy for patients with non-small cell lung cancer support the equivalency in the long-term survival between segmentectomy and lobectomy for small-sized earlystage NSCLC (2)(3)(4)(5)(6). Segmentectomy is chosen for the well-selected patients, for its advantage of preserving lung parenchyma, pulmonary function and a chance of future resections for secondary primary lung cancer (7).…”

Section: Introductionmentioning

confidence: 99%

Appropriate lymphadenectomy significantly reduced recurrence after segmentectomy for patients with non-small cell lung cancer

Wang¹,

Gu²,

Pan³

et al. 2018

J. Thorac. Dis.

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Background: Segmentectomy has been widely used for small-sized non-small cell lung cancer (NSCLC).The objective of this study is to determine the impact of number of harvested lymph nodes (LNs) on survival for patients undergoing segmentectomy. Methods: The clinicopathologic data of patients undergoing segmentectomy for NSCLC from July 2011 to December 2014 were retrospectively analyzed. Survival analysis was performed by Kaplan-Meier method and Cox regression analysis. Results: A total of 259 patients with NSCLC were eligible for analysis. Patients with harvested LN ≥6 had higher frequency of nodal metastasis in pathologic examination (9.4% vs. 1.5%, P=0.005). The 3-year recurrence-free survival (RFS) of patients with harvested LN ≥6 (90.2%) was significantly higher than that of patients with harvested LN <6 (73.7%, log-rank P=0.038). Multivariable Cox analysis identified harvested LN ≥6 as an independent predictor for improved RFS [hazard ratio (HR) =0.35; 95% confidence interval (CI): 0.14-0.90; P=0.029]. There was no significant difference in RFS between patients with harvested LN station ≥3 and <3 (log-rank P=0.34). Conclusions: The number of harvest LN ≥6 was independently associated with improved RFS for NSCLC patients undergoing segmentectomy, supporting the National Comprehensive Cancer Network (NCCN) guidelines of appropriate LN sampling.

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Lobectomy Versus Segmentectomy in Radiologically Pure Solid Small-Sized Non-Small Cell Lung Cancer

Abstract: Similar oncologic outcomes after lobectomy and segmentectomy were indicated among patients with radiologically pure solid small-sized NSCLC.

Cited by 64 publications

References 27 publications

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

Treatment Approaches in Lung Cancer

Appropriate lymphadenectomy significantly reduced recurrence after segmentectomy for patients with non-small cell lung cancer

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