Thoracoscopic Lobectomy Versus Sublobar Resection for pStage I Geriatric Non-Small Cell Lung Cancer

Abstract

ObjectivesThe choice of resection method for geriatric patients with early-stage non-small cell lung cancer (NSCLC) remains contentious. This study aimed to evaluate survival and perioperative outcomes after thoracoscopic lobectomy resection (LR) or sublobar resection (SR) in patients aged ≥75 years with pathologic stage (pStage) I NSCLC.Materials and MethodsWe retrospectively examined 258 consecutive patients aged ≥75 years with pStage I NSCLC who underwent thoracoscopic tumor resection at our institute from 2011 to 2018. Propensity score matching (PSM) analysis identified 60 patients in each group for comparison of survival-related parameters, including disease-free survival (DFS), lung cancer-specific overall survival (OS), and non-lung cancer-specific OS, using the Kaplan-Meier analysis.ResultsLR and SR were performed in 84 (32.6%) and 174 (67.4%) patients aged ≥75 years, respectively. The LR group had younger patients, better performance status, larger tumor sizes, and deeper tumor location than the SR group. Multivariate studies showed that the resection method was not a prognostic factor for OS. The two PSM-matched groups were not significantly different with respect to lung cancer-specific OS (p = 0.116), non-lung cancer-specific OS (p = 0.408), and DFS (p = 0.597). SR helped achieve better perioperative outcomes than LR, including fewer postoperative complications (10.0% vs. 28.3%, p = 0.011), shorter operative times (p < 0.001), decreased blood loss (p = 0.026), and shorter chest tube duration (p = 0.010) and hospital stays (p = 0.035).ConclusionsThoracoscopic SR may provide similar oncological outcomes to LR, but may be a safer and more feasible surgical method for geriatric patients with pStage I NSCLC.

Automated 3D Segmentation of the Aorta and Pulmonary Artery on Non-Contrast-Enhanced Chest Computed Tomography Images in Lung Cancer Patients

“…Low-dose computed tomography (CT) screening has recently increased the detection rate of early-stage lung cancer [1][2][3]. Thoracic surgical resection is the major treatment approach for patients with early-stage lung cancer [4][5][6][7]. Surgical planning may vary from patient to patient owing to different surgical risks across patients.…”

The predictive value of modified-DeepSurv in overall survivals of patients with lung cancer

“…However, in a previous study, the type of surgery was not a prognostic factor for either lung cancer-related or non-lung cancer-related OS in geriatric lung cancer patients. 25 However, in a nationwide propensity-matched study, there were significant differences in 1-year or 5-year survival rates among those who underwent different surgical methods for patients with lung cancer. 26 The effect of surgical methods on survival remains controversial.…”

Segmental Resection in Early-Stage Lung Cancer

“…Studies by Altorki et al, Lin et al also, have shown segmental resection for select early-stage lung cancer patients can provide good outcomes compared to lobectomy [2,3].…”