Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients?

Liu

Journal of Surgical Research

et al. 2019

Background: Segmentectomy and wedge resection have been recommended as appropriate surgical treatments for patients with poor pulmonary function or major comorbidities. However, for stage I nonesmall cell lung cancer (NSCLC), it is still undecided whether survival is better with segmentectomy or with wedge resection. Methods: A meta-analysis was performed of studies examining survival outcomes after sublobar resection in patients with stage I NSCLC. Three electronic databases were searched to identify studies that investigated overall survival, cancer-specific survival, and disease-free survival between patients receiving segmentectomy versus wedge resection. A total of 19 relevant studies published before 31 April 2018 that satisfied the inclusion criteria were included in this meta-analysis. Results: The 19 studies involved a total of 14,197 patients with stage I NSCLC. Overall survival was significantly better after segmentectomy than after wedge resection (hazard ratio [HR] ¼ 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.00001). This was also true of cancer-specific survival (HR ¼ 0.71; 95% CI, 0.64-0.79; P < 0.00001) and disease-free survival (HR ¼ 0.73, 95% CI, 0.54-0.98; P ¼ 0.04). A fixed-model was applied for the analysis as there was no significant heterogeneity between the studies. Conclusions: Survival after lobar resection for stage I NSCLC is significantly better with segmentectomy than with wedge resection.

Section: Introductionsupporting

confidence: 80%

Segmentectomy Versus Wedge Resection for Stage I Non–Small Cell Lung Cancer: A Meta-analysis

Liu

Journal of Surgical Research

et al. 2019

“…As lobectomy with systematic lymph node dissection is the current strategy for management of NSCLC in patients able to tolerate it, in theory T‐ALI should be treated as two primary tumors in different lobes. Thus, pneumonectomy, or at least bilobectomy (right lung) is more reasonable than lobectomy associated with sublobar resection in order to obtain a complete tumor resection and, thus reduce the risk of loco‐regional recurrence .…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of lung cancer with adjacent lobe invasion in relation to fissure integrity

et al. 2019

Self Cite

Background: Tumor with adjacent lobe invasion (T-ALI) is an uncommon condition. Controversy still exists regarding the optimal resection of adjacent lobe invasion, and the prognostic value in relation to fissure integrity at the tumor invasion point. The aims of this paper were to evaluate the prognosis of T-ALI with regard to fissure integrity, and type of resection. Methods: This was a retrospective multicenter study which included all consecutive patients with T-ALI undergoing surgical treatment. Based on radiological, intraoperative and histological findings, T-ALI patients were differentiated into two groups based on whether the fissure was complete (T-ALI-A group) or incomplete (T-ALI-D Group) at the level of tumor invasion point. Clinicopathological features and survival of two study groups were analyzed and compared. Results: Study population included 135 patients, of these 98 (72%) were included into T-ALI-A group, and 37 (38%) into T-ALI-D Group. T-ALI-D patients had better overall survival than T-ALI-A patients (63.9 AE 7.0 vs. 48.9 AE 3.9; respectively, P = 0.01) who presented with a higher incidence of lymph node involvement (35% vs. 4%; P = 0.004), and recurrence rate (43% vs. 16%; P = 0.01). At multivariable analysis, T-ALI-D (P = 0.01), pN0 stage (P = 0.0002), and pT≤5 cm (P = 0.0001) were favorable survival prognostic factors. Conclusions: T-ALI-D presented a better prognosis than T-ALI-A while extent of resection had no effect on survival. Thus, in patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe rather than lobectomy could be indicated. Key points• The extent of resection of adjacent lobe had no effect on survival while T-ALI-D, pN0 stage, and pT≤5 cm were significant prognostic factors. • In patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe could be indicated as an alternative to lobectomy.

“…Despite high‐quality evidence from multi‐institutional randomized controlled trials evaluating the efficacy of lobectomy versus sublobar resection in NSCLC (Cancer and Leukemia Group B 140503 trial, Japan Clinical Oncology Group 0802, and West Japan Oncology Group 4607L trial), an increasing number of retrospective reviews have demonstrated that sublobar resection is an acceptable alternative to lobectomy in patients with early‐stage NSCLC . Several recent studies have identified that sublobar resection is an effective equivalent to lobectomy for selected patients with stage IA NSCLC . Moreover, a recent study using SEER data demonstrated that sublobar resection is not inferior to lobectomy, even in patients aged ≤ 35 years with stage IA NSCLC .…”

Section: Discussionmentioning

confidence: 99%

Survival rates after lobectomy versus sublobar resection for early‐stage right middle lobe non‐small cell lung cancer

Dai

Rusidanmu

2018

Thoracic Cancer

BackgroundLung cancer in the right middle lobe has a poorer prognosis than tumors located in other lobes. The optimal surgical procedure for early‐stage non‐small cell lung cancer (NSCLC) in the right middle lobe has not yet been elucidated. The aim of this study was to compare survival rates after lobectomy and sublobar resection for early‐stage right middle lobe NSCLC.MethodsPatients who underwent lobectomy or sublobar resection for stage IA right middle lobe NSCLC tumors ≤ 2 cm between 2004 and 2014 were identified from the Surveillance, Epidemiology and End Results database of 18 registries. Cox regression model analysis was used to evaluate the prognostic factors. The lung cancer‐specific survival (LCSS) and overall survival (OS) rates between the two groups were compared.ResultsA total of 861 patients met our criteria, including 662 (76.9%) patients who underwent lobectomy and 199 (23.1%) patients who underwent sublobar resection. No statistical differences in LCSS and OS rates were identified between the groups of patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1–2 cm, lobectomy was associated with more favorable LCSS and OS rates compared to sublobar resection.ConclusionLobectomy and sublobar resection deliver a comparable prognosis for patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1–2 cm, lobectomy showed better survival rates than sublobar resection.