Outcomes of segmentectomy for cT1bN0M0 lung adenocarcinoma and squamous cell carcinoma: a possible association with pathological invasion

Ogawa, Hiroyuki; Uchino, Kenji; Tanaka, Yugo; Shimizu, Nobuyoshi; Okuda, Yusuke; Tane, Kenta; Hokka, Daisuke; Tane, Shinya; Tauchi, Shunsuke; Nishio, Wataru; Maniwa, Yoshimasa; Yoshimura, Masahiro

doi:10.1093/ejcts/ezu429

Cited by 12 publications

(17 citation statements)

References 24 publications

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“…After reviewing the full text, no RCTs were identified. Finally, 12 studies with lower-level evidence met the inclusion criteria and were included in the qualitative metaanalysis (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Literature Searchmentioning

confidence: 99%

“…Lobectomy has long been regarded as indispensable in the management of NSCLC, whereas sublobar resection is traditionally introduced when pulmonary function cannot tolerate lobectomy (5,6). However, recent studies indicate that performing segmentectomy in clinical T1N0M0 NSCLC might achieve a comparable prognosis to lobectomy (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, without a randomized controlled trial (RCT), all of these studies are low in evidence, with inevitable bias.…”

Section: Introductionmentioning

confidence: 99%

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Oncologic outcomes of lobectomy vs. segmentectomy in non-small cell lung cancer with clinical T1N0M0 stage: a literature review and meta-analysis

Zheng¹,

Zhai²,

Zhao³

et al. 2020

J Thorac Dis

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Background: Lobectomy has long been regarded as the standard treatment for operable non-small cell lung cancer (NSCLC). Recent studies suggested that segmentectomy could achieve a good prognosis for early-stage NSCLC and might be an alternative to lobectomy in this cohort. Until now, on the issue of comparison between lobectomy and segmentectomy, there remains no published randomized controlled trial (RCT), and all existing evidence is low. Recently, a categorization of lower-level evidence has been proposed, namely, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.The aim of this meta-analysis is to compare the oncologic outcome between lobectomy and segmentectomy in NSCLC with the clinical T1N0M0 stage according to the GRADE system.Methods: PubMed, the PMC database, EMBASE, Web of Science, and the Cochrane library were searched prior to May 2019 to identify studies that compared the prognosis between lobectomy and segmentectomy for clinical T1N0M0 NSCLC. The evidence level of the included studies was assessed according to the GRADE system, including level IIA, probably not confounded nonrandomized comparison; level IIB, possibly confounded nonrandomized comparison; and level IIC, probably confounded nonrandomized comparison. The predefined outcomes included overall survival (OS) and disease-free survival (DFS).Univariable and multivariable hazard ratios (HRs) with 95% confidence intervals (95% CI) were pooled using a random-effects model. Results: Twelve nonrandomized studies involving 8,072 participants were included. Of these studies, two were classified as IIA level (16.7%), six as IIB level (50.0%), and four as IIC level (33.3%). When crude HRs were included, compared with lobectomy, segmentectomy was associated with shorter OS but comparable DFS in the entire cohort (OS, pooled HR =1.45, 95% CI, 1.23 to 1.67; DFS, pooled HR =1.03, 95% CI, 0.65 to 1.82) and in patients with nodules ≤2 cm (OS, pooled HR =1.55, 95% CI, 1.33 to 1.80; DFS, pooled HR =0.98, 95% CI, 0.55 to 1.77). When adjusted HRs were included, the impact of segmentectomy on OS and DFS was comparable to that of lobectomy in the entire cohort (OS, pooled HR =1.39, 95% CI, 0.92 to 2.10; DFS, pooled HR =0.83, 95% CI, 0.66 to 1.03) and in patients with nodules ≤2 cm (OS, pooled HR =1.61, 95% CI, 0.87 to 3.00; DFS, pooled HR =0.90, 95% CI, 0.63 to 1.27).Conclusions: Based on our results, although shorter OS is observed in patients received segmentectomy, it is necessary to wait for more results from RCT to draw a valid conclusion.

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Section: Literature Searchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oncologic outcomes of lobectomy vs. segmentectomy in non-small cell lung cancer with clinical T1N0M0 stage: a literature review and meta-analysis

Zheng¹,

Zhai²,

Zhao³

et al. 2020

J Thorac Dis

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“…Отдельная группа исследователей указывает на то, что при опухоли до 2 см достоверной разницы отдаленных результатов лечения пациентов после лобэктомии и сег-ментэктомии не получено [28,29]. Ряд авторов [30] отме-чают большую частоту локорегионарного рецидива после сегментэктомии при T1-2N0M0 (12%), чем после лоб-эктомии (1,2%).…”

Section: Discussionunclassified

Surgical treatment in patients with Stage I peripheral non-small cell lung cancer: Results, prognosis, prospects

Колбанов¹,

Trakhtenberg²,

Пикин³

et al. 2016

Onkol. Z. im. P.A. Gercena

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Хирургическое лечение больных периферическим немелкоклеточным раком легкого I стадии: результаты, прогноз, перспективы К.И. Колбанов, а.Х. ТраХТенберг , о.в. ПИКИн, в.а. глушКо, в.а. багров Московский научно-исследовательский онкологический институт им. П.а. герцена -филиал Фгбу «национальный медицинский исследовательский радиологический центр» (дир. -чл.-корр. ран а.Д. Каприн) Минздрава россии, Москва, россия у функционально операбельных больных немелкоклеточным раком легкого (нМрл) методом выбора считают хирургиче-ское лечение, минимальный объем которого лобэктомия с медиастинальной лимфаденэктомией. Цель исследования -ретроспективная оценка результатов хирургического лечения больных периферическим нМрл Т1-2аN0M0 с учетом объема операции и ряда других клинико-морфологических факторов. Материал и методы. в анализ включены 363 паци-ента c периферическим нМрл до 4 см без метастазов в лимфатических узлах, которым выполнены лобэктомия (91,2%), сегментэктомия (3,6%) и неанатомическая резекция легкого (5,2%). Средний возраст больных составил 59,8 года, преоб-ладали мужчины (80,2%). опухоль относительно чаще локализовалась в правом легком (54,0%) и верхних долях (66,1%). у 188 пациентов диагностирована IA стадия (pT1а-bN0M0), у 175 -IB (рT2aN0M0). аденокарцинома выявлена у 47,4% больных, плоскоклеточный рак -у 39,2%, крупноклеточный -у 5,8%, аденоплоскоклеточный -у 6,0% и мукоэпидермо-идный -у 1,6%. Результаты. Послеоперационные осложнения диагностированы у 10,2% пациентов, летальность соста-вила 1,4%. общая 5-летняя выживаемость больных достигала 71%: при Т1a-b -76,1%, Т2а -67,1% (р>0,05). лучшие показатели наблюдались при плоскоклеточном раке (77,5%) и аденокарциноме (68,0%; р>0,05), более низкие -крупно-клеточном раке (50,4%; р=0,03). установлен неблагоприятный прогноз у больных после неанатомической резекция легко-го (43,8%; р<0,001) по сравнению с лобэктомией, выполненной из трансторакального доступа (72,4%) и сегментэктоми-ей (81,5%, р>0,05). Показатель общей 5-летней выживаемости после видеоторакоскопической лобэктомии сопоставим (77,6%) с таковым при торакотомных. При многофакторном анализе подтверждено негативное влияние на отдаленные результаты хирургического лечения морфологического типа нМрл и объема операции. Заключение. К неблагоприятным клинико-морфологическим факторам прогноза хирургического лечения больных нМрл (Т1-2аN0M0) следует относить крупноклеточный рак легкого и операцию в объеме неанатомической сублобарной резекции. Сегментэктомию как стан-дарт объема лечения можно рассматривать только у больных нМрл T1aN0M0. surgical treatment, the minimal volume of which is lobectomy with mediastinal lymphadenectomy, is considered the method of choice in functionally operable patients with non-small cell lung cancer (NsClC). Objective: to retrospectively assesse the results of surgical treatment in patients with peripheral NsClC (T1-2aN0M0) in view of the volume of surgery and a number of other clinical and morphological factors. Subjects and methods. The analysis included 363 patients with a peripheral NsCl...

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“…К аналогичным выводам пришла группа японских авторов H. Ogawa и соавт. [44], проведя отдельный анализ результатов 31 сегментэктомии и 147 лобэктомий у больных НМРЛ (T1bN0M0) IA стадии с размером опухоли более 2, но менее 3 см. Различие в общей 5-летней выживаемости оказалось статистически недостоверным (77,4 и 81,6% соответственно; р=0,73).…”

Section: сегментэктомия при периферическом нмрл Ia стадииunclassified

Segmentectomy in patients with malignant tumors of the lung

Амиралиев¹,

Пикин²,

Ryabov³

et al. 2017

Onkol. Z. im. P.A. Gercena

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Segmentectomy as an organ-sparing variant of anatomical lung resection, which was developed even in the first half of the twentieth century, has traditionally been used to treat tuberculosis and other nontumor diseases. Many studies that evaluate the feasibility and appropriateness of sublobar anatomical resection for lung cancer are presently conducted in different countries of the world. The works that are published on this topic and available in the international medical databases are analyzed. The literature review highlights the history of development, classifications, and the possibilities of using segmentectomy for Stage 1 peripheral non-small cell lung cancer and metastases, the technical aspects of preoperative planning with regard to the individual features of the anatomy of the segmental vessels and bronchi, and methods for imaging and separation of the intersegmental borders.

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Outcomes of segmentectomy for cT1bN0M0 lung adenocarcinoma and squamous cell carcinoma: a possible association with pathological invasion

Abstract: The results of our study suggest that segmentectomy may not be recommended for cT1b tumours if pathological invasion is suspected before surgery.

Cited by 12 publications

References 24 publications

Oncologic outcomes of lobectomy vs. segmentectomy in non-small cell lung cancer with clinical T1N0M0 stage: a literature review and meta-analysis

Oncologic outcomes of lobectomy vs. segmentectomy in non-small cell lung cancer with clinical T1N0M0 stage: a literature review and meta-analysis

Surgical treatment in patients with Stage I peripheral non-small cell lung cancer: Results, prognosis, prospects

Segmentectomy in patients with malignant tumors of the lung

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