National trends in the quality of segmentectomy for lung cancer

Logan, Charles D; Jacobs, Ryan C.; Feinglass, Joe; Lung, Kalvin; Kim, Samuel; Bharat, Ankit; Odell, David D.

doi:10.1016/j.jtcvs.2022.05.050

Cited by 13 publications

(8 citation statements)

References 49 publications

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“…This occurred despite the decrease in high‐risk patients over time (i.e., major comorbidities, decreased pulmonary reserve). Analysis of treatment patterns from 2004 to 2018 in the National Cancer Database of 249 391 patients with clinical stage I to IIA NSCLC also demonstrated an increase in segmentectomies performed annually from 3.3% in 2004 to 6.1% in 2018 65 . At our institution, the rate of segmentectomy has also increased over the last 5 years from 14% in 2019 to 23% in the first three quarters of 2023.…”

Section: The Trend Toward Segmentectomymentioning

confidence: 51%

What's new in thoracic oncology

Pezeshkian,

McAllister,

Singh

et al. 2023

Journal of Surgical Oncology

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Many changes have occurred in the field of thoracic surgery over the last several years. In this review, we will discuss new diagnostic techniques for lung cancer, innovations in surgery, and major updates on latest treatment options including immunotherapy. All these have significantly started to change our approach toward the management of lung cancer and have great potential to improve the lives of our patients afflicted with this disease.

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Section: The Trend Toward Segmentectomymentioning

confidence: 51%

What's new in thoracic oncology

Pezeshkian,

McAllister,

Singh

et al. 2023

Journal of Surgical Oncology

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“…Owing to the inherent heterogeneity of this procedure, a clear guideline or reporting protocol for optimal segmentectomy is needed. If several criteria for the quality measure were applied, the actual acceptable rate of segmentectomy would decrease, as exhibited in the National Cancer Database study 7 . Therefore, studies that re‐evaluate the quality of segmentectomies would be a good starting point for more transparency.…”

Section: Discussionmentioning

confidence: 99%

“…However, the higher recurrence rate after segmentectomy is concerning. Additionally, segmentectomy procedures are not clearly defined among thoracic surgeons in academic and nonacademic settings 7 . Owing to the technical difficulty and complexity of segmental structures, appropriate processes must be developed.…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, 19.2% of segmentectomies were classified as nonanatomical, even in highly academic settings. A National Cancer Database study from the USA also demonstrated a heterogeneous description of segmentectomy, with only 12.6% meeting all quality measures 7 . This alarmed the surgical society and urged them to develop and evaluate the appropriateness of segmentectomies, including mediastinal lymph node dissection (MLND), optimal surgical candidates, and sufficient resection margins.…”

Section: Introductionmentioning

confidence: 99%

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Segmentectomy quality remains important in ground‐glass‐dominant stage I lung cancer

Woo,

Lee,

Jin

et al. 2023

Thoracic Cancer

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BackgroundSegmentectomy for early‐stage lung cancer has benefits for survival and parenchymal preservation. However, segmentectomies are technically challenging, thereby resulting in considerable variability in the quality of resection. In this study, we aimed to review the quality of segmentectomies and analyze their clinical impact.MethodsThis retrospective study reviewed patients diagnosed with stage I lung cancer after segmentectomies between 2013 and 2021. Segmentectomies were classified as anatomical or nonanatomical; anatomical resection included segmental bronchus and vessel (artery and/or vein) divisions; others were classified as nonanatomical. The primary outcome was recurrence‐free and overall survival, and the secondary outcome was postoperative spirometry and lung plication, which is seen as a fibrotic line along the stapling site.ResultsOf the 132 segmental resections included in this study, 101 (76.5%) were anatomical segmentectomies. The median consolidation‐tumor ratio was 0.40, and 83.3% (110/132) had ground‐glass opacities (GGOs). Compared to nonanatomical resections, more N1 and total lymph node stations were retrieved after anatomical segmentectomies. Regarding clinical outcomes, recurrence‐free survival was better after anatomical segmentectomy (p = 0.049); however, overall survival was not significantly different (p = 0.064). Furthermore, at 3–6 months postoperatively, thicker lung plication at the stapling site was observed in nonanatomical resections (p < 0.001). Subgroup analysis for complex segmentectomies revealed a larger decrease in forced‐expiration volume in 1 s after nonanatomical resection.ConclusionAnatomical segmentectomy resulted in better survival and a lower incidence of thick lung plication, even in GGO‐dominant tumors. Therefore, further standardization and quality management of segmentectomy procedures will improve the clinical outcomes.

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“…With the increasing detection of early-stage lung cancer in the older adult population, the use of lung-preserving resections such as wedge resection and segmentectomy has grown globally. 1 , 2 A recent large prospective trial comparing segmentectomy and lobectomy (JCOG0802/WJOG4607L) demonstrated the superiority of segmentectomy over lobectomy for small-sized peripheral non-small lung cancer. 3 The noninferiority of sublobar resection to lobectomy regarding patient survival, as demonstrated in another large prospective trial comparing sublobar resection (including both segmentectomy and wedge resection) and lobectomy (CALGB140503), further supports the use of sublobar resection, including segmentectomy.…”

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confidence: 99%

Segmentectomy-oriented anatomical model for enhanced precision surgery of the left upper lobe

Matsuoka,

Eguchi,

Seshimoto

et al. 2023

JTCVS Techniques

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National trends in the quality of segmentectomy for lung cancer

Cited by 13 publications

References 49 publications

What's new in thoracic oncology

What's new in thoracic oncology

Segmentectomy quality remains important in ground‐glass‐dominant stage I lung cancer

Segmentectomy-oriented anatomical model for enhanced precision surgery of the left upper lobe

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