Survival outcomes in a prospective randomized multicenter Phase III trial comparing patients undergoing anatomical segmentectomy versus standard lobectomy for non-small cell lung cancer up to 2 cm

Stamatis, Georgios; Leschber, Gunda; Schwarz, Birte; Brintrup, Diana Lütke; Flossdorf, Sarah; Passlick, Bernward; Hecker, Erich; Kügler, Christian; Eichhorn, Martin; Krbek, Thomas; Eggeling, Stephan; Hatz, Rudolf; Müller, Michael; Hillinger, Sven; Aigner, Clemens; Jöckel, Karl‐Heinz

doi:10.1016/j.lungcan.2022.08.013

Cited by 42 publications

(26 citation statements)

References 34 publications

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“…Six papers reported 30-day mortality: there were no events in 1766 procedures [8,9,18,20,24,26]. Five articles (2173 patients) reported the number of patients with postoperative complications.…”

Section: Meta-analysis: Secondary Outcomesmentioning

confidence: 99%

“…Moreover, segmentectomy cannot be considered equivalent for every portion of parenchyma, and often authors do not report which segments and how many lung segments were removed (e.g., very common is the resection of the culmen, which actually includes three segments). Recently, two randomized controlled trials were published [8,9]). These new data need to be analyzed together with the previous ones to shed new light on the controversial topic of the appropriateness of segmentectomy.…”

Section: Introductionmentioning

confidence: 99%

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Oncological Outcomes of Segmentectomy versus Lobectomy in Clinical Stage I Non-Small Cell Lung Cancer up to Two Centimeters: Systematic Review and Meta-Analysis

Righi

Maiorca

Diotti

et al. 2023

Life

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Objective. In recent years, pulmonary segmentectomy has emerged as an alternative to lobectomy for the treatment of patients with clinical stage I non-small cell lung cancer. Considering the conflicting results reported in the literature, the oncological effectiveness of segmentectomy remains controversial. To provide new insight into oncological results, we reviewed the literature, including recent randomized trials. Methods. We performed a systematic review for surgical treatment of stage I NSCLC up to 2 cm using MEDLINE and the Cochrane Database from 1990 to December 2022. Primary outcomes for pooled analysis were overall and disease-free survival; secondary outcomes were postoperative complications and 30-day mortality. Results. Eleven studies were considered for the meta-analysis. The pooled analysis included 3074 and 2278 patients who received lobectomy and segmentectomy, respectively. The estimated pooled hazard ratio showed a similar hazard for segmentectomy compared to lobectomy in terms of overall and disease-free survival. The restricted mean survival time difference between the two procedures was statistically and clinically not significant for overall and disease-free survival. Nevertheless, the overall survival hazard ratio was time-dependent: segmentectomy was at a disadvantage starting from 40 months after surgery. Six papers reported 30-day mortality: there were no events on 1766 procedures. The overall relative risk showed that the postoperative complication rate was higher in segmentectomy compared to lobectomy, without statistical significance. Conclusions. Our results suggest that segmentectomy might be a useful alternative to lobectomy for stage I NSCLC up to 2 cm. However, this appears to be time-dependent; in fact, the risk ratio for overall mortality becomes unfavorable for segmentectomy starting at 40 months after surgery. This last observation, together with some still undefined questions (solid/non-solid ratio, depth of the lesion, modest functional savings, etc.), leave room for further investigations on the real oncological effectiveness of segmentectomy.

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Section: Meta-analysis: Secondary Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oncological Outcomes of Segmentectomy versus Lobectomy in Clinical Stage I Non-Small Cell Lung Cancer up to Two Centimeters: Systematic Review and Meta-Analysis

Righi

Maiorca

Diotti

et al. 2023

Life

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“…Erste größere Datenbankanalysen [ 62 ] zeigten keinen Unterschied. Seither gingen zahlreiche retrospektive und prospektive Studien dieser Frage nach [ 63 ]. Neueste Studien [ 21 , 23 , 25 ] finden sich in Tab.…”

Section: Prä- Peri- Und Postoperative Optimierungsmöglichkeitenunclassified

Chirurgie des alten Menschen – Thoraxchirurgie

Ehrsam

Aigner

2022

Chirurgie

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Hintergrund Eine Vielzahl thoraxchirurgisch relevanter Krankheitsbilder häuft sich mit steigendem Alter. Hohes Alter wird aber häufig als Kontraindikation für kurative Eingriffe oder größere operative Eingriffe per se gesehen. Ziel der Arbeit Darlegung der aktuellen relevanten Studienlage, Ableitung von Empfehlungen zur PatientInnenselektion sowie prä-, peri- und postoperativen Optimierung. Material und Methoden Auswertung der aktuellen Studienlage. Ergebnisse Wie aktuelle Daten zeigen, ist das Alter für die meisten thorakalen Erkrankungen allein kein Grund eine chirurgische Behandlung vorzuenthalten. Bei der Selektion gilt es viel mehr, Komorbiditäten, Gebrechlichkeit, Mangelernährung und kognitive Einschränkungen zu berücksichtigen. Eine Lobektomie oder Segmentresektion bei nichtkleinzelligem Lungenkrebs (NSCLC) im Stadium I kann bei gut selektionierten > 80-jährigen PatientInnen zu akzeptablen bis sogar vergleichbar guten Kurz- und Langzeitergebnissen führen wie bei jüngeren. Ausgewählte > 75-jährige PatientInnen mit NSCLC im Stadium II–IIIA können sogar von einer adjuvanten Chemotherapie profitieren. Nach guter Selektion sind Hochrisikoeingriffe wie eine Pneumonektomie bei > 70-Jährigen und pulmonale Endarteriektomie bei > 80-Jährigen ohne erhöhte Mortalitätsraten möglich. Und auch die Lungentransplantation kann bei gut selektionierten > 70-jährigen PatienInnen zu einem guten Langzeitergebnis führen. Minimal-invasive Operationsverfahren und nichtintubierte Anästhesie tragen zur Risikoreduktion bei marginalen PatientInnen bei. Diskussion In der Thoraxchirurgie ist nicht das numerische Alter, sondern das biologische Alter entscheidend. Zur Optimierung der Selektion, der Eingriffe, der Vor- und Nachbehandlung sowie der Lebensqualität sind angesichts der immer älter werdenden Bevölkerung dringend weitere Studien nötig.

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“…The CALGB and JCOG/WJOC trials could change current practice, but they leave some problems unsolved: (i) not all the segments are equally easy to resect, and thus technical issues may arise; (ii) costs may be higher if adjuvant treatments/additional surgeries are needed (indeed, local recurrence in the segmentectomy group was nearly double that of the lobectomy group); (iii) lung function preservation may also not be significant enough to justify the risks [ 4 , 10 ]. Some papers have, however, reported that the incidence of local and distant cancer recurrence seems not to be influenced by the extension of parenchymal resection [ 11 ], but a percentage of patients, varying from 30% to 55%, develops disease recurrence and eventually dies despite an initial resection with curative intent [ 12 , 13 ]. Thus, a more efficient identification and selection of those lung cancer patients who will really benefit from surgery is needed.…”

Section: Introductionmentioning

confidence: 99%

Smoking Habit and Respiratory Function Predict Patients’ Outcome after Surgery for Lung Cancer, Irrespective of Histotype and Disease Stage

Piloni

Bertuccio

Primiceri

et al. 2023

JCM

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Background. Growing evidence suggests that sublobar resections offer more favorable outcomes than lobectomy in early-stage lung cancer surgery. However, a percentage of cases that cannot be ignored develops disease recurrence irrespective of the surgery performed with curative intent. The goal of this work is thus to compare different surgical approaches, namely, lobectomy and segmentectomy (typical and atypical) to derive prognostic and predictive markers. Patients and Methods. Here we analyzed a cohort of 153 NSCLC patients in clinical stage TNM I who underwent pulmonary resection surgery with a mediastinal hilar lymphadenectomy from January 2017 to December 2021, with an average follow-up of 25.5 months. Partition analysis was also applied to the dataset to detect outcome predictors. Results. The results of this work showed similar OS between lobectomy and typical and atypical segmentectomy for patients with stage I NSCLC. In contrast, lobectomy was associated with a significant improvement in DFS compared with typical segmentectomy in stage IA, while in stage IB and overall, the two treatments were similar. Atypical segmentectomy showed the worst performance, especially in 3-year DFS. Quite unexpectedly, outcome predictor ranking analysis suggests a prominent role of smoking habits and respiratory function, irrespective of the tumor histotype and the patient’s gender. Conclusions. Although the limited follow-up interval cannot allow conclusive remarks about prognosis, the results of this study suggest that both lung volumes and the degree of emphysema-related parenchymal damage are the strongest predictors of poor survival in lung cancer patients. Overall, these data point out that greater attention should be addressed to the therapeutic intervention for co-existing respiratory diseases to obtain optimal control of early lung cancer.

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Survival outcomes in a prospective randomized multicenter Phase III trial comparing patients undergoing anatomical segmentectomy versus standard lobectomy for non-small cell lung cancer up to 2 cm

Cited by 42 publications

References 34 publications

Oncological Outcomes of Segmentectomy versus Lobectomy in Clinical Stage I Non-Small Cell Lung Cancer up to Two Centimeters: Systematic Review and Meta-Analysis

Oncological Outcomes of Segmentectomy versus Lobectomy in Clinical Stage I Non-Small Cell Lung Cancer up to Two Centimeters: Systematic Review and Meta-Analysis

Chirurgie des alten Menschen – Thoraxchirurgie

Smoking Habit and Respiratory Function Predict Patients’ Outcome after Surgery for Lung Cancer, Irrespective of Histotype and Disease Stage

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