Short‐term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm

Abstract

Introduction VATS pulmonary segmentectomy is increasingly proposed as a parenchyma‐sparing resection for tumors smaller than 2 cm in diameter. The aim of this study was to compare short‐term oncological results and local control in solid non‐small cell lung cancers (NSCLCs) <2 cm surgically treated by intentional VATS segmentectomy or lobectomy. Methods This study was a single center retrospective study of consecutive patients undergoing VATS lobectomy (VL) or segmentectomy (VS) for solid <2 cm NSCLC from January 2014 to October 2019. Results In total, 188 patients with a median age of 65 years (male/female: 99/89) underwent VS (n = 96) or VL (n = 92). Segmentectomies in the upper lobes were performed in 57% and as a single segment in 55% of cases. There was no statistically significant difference between VS and VL in terms of demographics, comorbidities, postoperative outcomes, dissected lymph node stations (2.89 ± 0.95 vs. 2.93 ± 1, P = 0.58), rate of pN1 (2.2% vs. 2.1%, P = 0.96) or pN2 upstaging (1.09% vs. 1.06%, P = 0.98). Adjuvant chemotherapy was given in 15% of patients in the VL and 11% in the VS group. During follow‐up (median: 23 months), no patients presented with local nodal recurrence or on the stapler line (VS group). Three patients on VL and two in VS groups presented with recurrence on the remnant operated lung. New primary pulmonary tumors were diagnosed in 3.3% and 6.3% of patients in the VL and VS groups, respectively. Conclusions Despite the short follow‐up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy for patients with NSCLC <2 cm.

Minimally Invasive Anatomical Segmentectomy versus Lobectomy in Stage IA Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

“…The manual search of reference lists and the electronic database search yielded a total of 887 publications. Among them, 10 retrospective studies met our eligibility criteria ( Figure 2 ) for a total of 1953 patients: 550 underwent minimally invasive anatomical segmentectomy, and 1403 underwent minimally invasive lobectomy [ 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The characteristics of the included papers are presented in Table 1 .…”

“…Screening programs for lung cancer have improved the detection of small nodules and GGO. As a result, the efficacy of lobectomy versus sublobar resection for early-stage NSCLC has been questioned [ 8 ]. Systematic reviews demonstrate that segmentectomy can obtain the same survival results as lobectomy in people with stage I NSCLC, with a paucity of studies on minimally invasive anatomical segmentectomy [ 28 ].…”

“…Authors’ assessments of each risk of bias item for each study included. The green and red circles correspondingly represent a low and high risk of bias [ 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

“…Several challenges still exist regarding the extent of curative lung resection, and minimally invasive lobectomy and segmentectomy have been refined over the past decade [ 7 ]. In addition, current research suggests that pure GGO are amenable to segmentectomy, thus generating selection bias due to the inferior aggressiveness and more favorable oncological prognosis of GGO themselves [ 8 ].…”

How I do VATS segmentectomy: the uniportal approach

“…Pulmonary segmentectomy is a surgical technique designed to spare healthy parenchyma. It is generally offered for diagnostic and treatment purposes in cases of centrally located nodules or metastases as well as for peripheral earlystage non-small cell lung cancer (NSCLC) (1,2). Over the past decades, resections of lesser than lobar extent (including wedge resections or segmentectomies) were merely seen as a secondary surgical option for patients who were unfit for lobectomy due to an overly diminished lung function (3,4).…”