Outcomes of Sublobar Resection Versus Lobectomy for Stage I Non–Small Cell Lung Cancer: A 13-Year Analysis

El-Sherif, Amgad; Gooding, William E.; Santos, Ricardo; Pettiford, Brian L.; Ferson, Peter F.; Fernando, Hiran C.; Urda, Susan J.; Luketich, James D.; Landreneau, Rodney J.

doi:10.1016/j.athoracsur.2006.02.029

Cited by 321 publications

(196 citation statements)

References 29 publications

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“…The 5-yr survival rates of lobectomy and sublobar resection were equivalent, except in six studies [25,27,35,36,40,42]. WARREN et al [25] compared the survival of 103 patients who had undergone lobectomy with the survival of 66 patients who had undergone segmentectomy: 5-yr survival was significantly better for those who had undergone lobectomy (65% versus 45%).…”

Section: Survival and Recurrencementioning

confidence: 99%

“…In the series of EL-SHERIF et al [35], both stage IA and IB tumours were included. Lobectomy was performed in 577 patients, and sublobar resection in 207 (122 wedge resections and 85 segmentectomies).…”

Section: Survival and Recurrencementioning

confidence: 99%

“…SUBLOBAR RESECTIONS FOR SMALL SOLID AND PARTLY SOLID PERIPHERAL TUMOURS Indications Table 1 shows the most relevant data from 20 studies comparing lobectomy with sublobar resection [8,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. All but three were retrospective: one was a prospective but nonrandomised study [28] and two were prospective observational studies [20,34].…”

Section: Upper Lobementioning

confidence: 99%

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Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2008

European Respiratory Journal

101

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Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged .71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of f2 cm, segmentectomy is equivalent to lobectomy, but survival after segmentectomy is worse if performed for larger tumours. For both segmentectomy and wedge resection, tumour margins should be o1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of f2 cm, diagnosed intraoperatively with certainty, sublobar resection seems equivalent to lobectomy, and because there is no nodal involvement, systematic nodal dissection may not be necessary. In case of doubt, however, lobectomy with systematic nodal dissection will ensure complete resection and adequate staging. More randomised trials are needed to confirm all these issues.

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Section: Survival and Recurrencementioning

confidence: 99%

Section: Survival and Recurrencementioning

confidence: 99%

Section: Upper Lobementioning

confidence: 99%

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Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2008

European Respiratory Journal

101

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“…12,13) One of the most important points for deciding to perform a segmentectomy was intraoperative accurate assessment of intrasegmental, hilar and mediastinal lymph nodes. Sentinel node navigation surgery was a useful tool to evaluate the metastases of lymph nodes and molecular diagnosis to detect micrometastasis.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Segmentectomy with Intraoperative Evaluation of Sentinel Nodes for Stage I Non-Small Cell Lung Cancer

Moroga

Yamashita

Tokuishi

et al. 2012

Ann Thorac Cardiovasc Surg

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Objectives: Segmentectomy is the treatment of choice for small-sized non-small cell lung cancer (NSCLC); however, it is difficult to decide the surgical procedure because accurate evaluation of hilar lymph node metastasis remains unclear. We here report the outcome of video-assisted thoracic surgery (VATS) segmentectomy with and without the assessment of sentinel nodes. Materials and Methods: Eighty-three patients with stage IA NSCLC underwent VATS segmentectomy between January 2003 and December 2010. Twenty patients underwent indocyanine green fluorescence imaging for sentinel node biopsy (SNB) and 63 did not. Intraoperative real-time quantitative RT-PCR to determine the expression of CK-19 was used for evaluation of metastasis. Perioperative outcome, local recurrence rates and survival were compared in both groups. Results: Sentinel lymph nodes were identified in 16 of 20 patients (80%) with segmentectomy in the SNB group. The false negative rate was 0%. By RT-PCR for CK-19 expression, only one of these patients showed positive sentinel nodes, which indicated isolated tumor cells; however, segmentectomy was not converted to lobectomy. Seven of 63 patients with VATS segementectomy without SNB and none of the SNB group relapsed. In the relapsed patients without SNB, 4 (6.3%) were local recurrences and 3 (4.7%) were distant metastases. Recurrence-free survival rates in both groups were not significantly different because of the short follow-up period of the SNB group. Conclusions: Our study demonstrated that VATS segmentectomy with SNB was useful for deciding intraoperatively to perform segmentectomy with an accurate lymph node status.

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“…This was due to the finding of inferior outcomes with the sublobar approach (2), and was related to increased local tumor recurrence and decreased survival in these patients, when compared with lobectomy. Other studies have also shown worse longterm outcomes of patients treated with limited resections for early stage NSCLC when compared with lobectomy (3-5), while a 13-year analysis of sublobar resection versus lobectomy for stage 1 non-small cell lung cancer, published in 2006 by El-Sherif et al found no difference in diseasefree survival between these two types of resection (6). More recently, mounting evidence suggests that sublobar resection may be an acceptable surgical treatment in certain patients with smaller early stage NSCLC (7), with equivocal survival noted with wedge resection when compared with segmentectomy (8,9).…”

mentioning

confidence: 99%