Wedge resection versus segmentectomy in patients with stage I non–small-cell lung cancer unfit for lobectomy

Tsutani, Yasuhiro; Kagimoto, Atsushi; Handa, Yoshinori; Mimae, Takahiro; Miyata, Yoshihiro

doi:10.1093/jjco/hyz122

Cited by 24 publications

(37 citation statements)

References 19 publications

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“…A retrospective study indicated that sub-lobar resection might achieve similar survival rates to lobectomy in elderly stage I NSCLC patients (10). A result was observed in that segmentectomy failed to show superiority in terms of survival compared with wedge resection for patients with stage I NSCLC (11). Thus, the optimal extent of resection for elderly patients with stage IA disease remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching’s Study

Zhang

Liu

et al. 2021

Front. Oncol.

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BackgroundTo investigate the differences in survival between lobectomy and sub-lobar resection for elderly stage I non-small-cell lung cancer (NSCLC) patients using the Surveillance, Epidemiology, and End Results (SEER) registry.MethodThe data of stage IA elderly NSCLC patients (≥ 70 years) with tumors less than or equal to 3 cm in diameter were extracted. Propensity-matched analysis was used. Lung cancer-specific survival (LCSS) was compared among the patients after lobectomy and sub-lobar resection. The proportional hazards model was applied to identify multiple prognostic factors.ResultsA total of 3,504 patients met criteria after propensity score matching (PSM). Although the LCSS was better for lobectomy than for sub-lobar resection in patients with tumors ≤ 3 cm before PSM (p < 0.001), no significant difference in the LCSS was identified between the two treatment groups after PSM (p = 0.191). Multivariate Cox regression showed the elder age, male gender, squamous cell carcinoma (SQC) histology type, poor/undifferentiated grade and a large tumor size were associated with poor LCSS. The subgroup analysis of tumor sizes, histologic types and lymph nodes (LNs) dissection, there were also no significant difference for LCSS between lobectomy and sub-lobar resection. The sub-lobar resection was further divided into segmentectomy or wedge resection, and it demonstrated that no significant differences in LCSS were identified among the treatment subgroups either. Multivariate Cox regression analysis showed that the elder age, poor/undifferentiated grade and a large tumor size were a statistically significant independent factor associated with survival.ConclusionIn terms of LCSS, lobectomy has no significant advantage over sub-lobar resection in elderly patients with stage IA NSCLC if lymph node assessment is performed adequately. The present data may contribute to develop a more suitable surgical treatment strategy for the stage IA elderly NSCLC patients.

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Section: Introductionmentioning

confidence: 99%

Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching’s Study

Zhang

Liu

et al. 2021

Front. Oncol.

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“…Patients who cannot tolerate radical surgery are frequently older patients with comorbidities or impaired pulmonary function. Several studies have reported that segmentectomy and wedge resection show similar survival rates for patients who are unfit for lobectomy ( 6 – 9 ). Additionally, although wedge resection is a non-anatomical resection, it may be optimal for patients who cannot undergo lobectomy.…”

Section: Introductionmentioning

confidence: 99%

Thermal Ablation Versus Wedge Resection for Stage I Non-small Cell Lung Cancer Based on the Eighth Edition of the TNM Classification: A Population Study of the US SEER Database

et al. 2020

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Background The incidence rates of early-stage non-small cell lung cancer (NSCLC) are now increasing, and therapies such as thermal ablation have shown potential therapeutic promise. This study aimed to determine the influence of different surgical methods on overall survival (OS) and cancer-specific survival (CSS) in patients with stage I NSCLC. Methods Patients diagnosed with stage I NSCLC who had received thermal ablation or wedge resection between 2004 and 2014 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed according to the surgical method. Kaplan–Meier curves and a Cox proportional hazard model were used to evaluate OS and CSS. Results In all, 4,372 patients with stage I NSCLC were included. Before PSM, the respective 3- and 5-year OS rates were 68.9 and 52.7% in the wedge resection group and 68.5 and 47.8% in the thermal ablation group ( p < 0.0001); the corresponding CSS rates were 79.1 and 69.4% and 62.6 and 46.0% ( p < 0.0001). After PSM, survival analysis showed that wedge resection had better OS (44.5% vs. 30.1%, p = 0.033) and CSS (63.5% vs. 46%, p = 0.038) than thermal ablation. After PSM, Cox regression showed that treatment was not associated with OS or CSS. For patients aged >75 years, thermal ablation showed similar OS and CSS as wedge resection (OS: 30.6% vs. 41.7%, p = 0.470; CSS: 46.4% vs. 64.1%, p = 0.100). After PSM, thermal ablation still had OS (30.6% vs. 41.0%, p = 0.470) and CSS (46.4% vs. 59.8%, p = 0.100) comparable to wedge resection. Conclusion For patients with stage I NSCLC who are unfit for lobectomy, thermal ablation could be a potential therapeutic option, especially for those >75 years old.

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“…15 It is reported that oncological results similar to lobectomy were obtained with segmentectomy for the surgical treatment of early stage non-small cell lung cancer. [1][2][3]6,7,11 Segmentectomy may be an alternative to lobectomy in non-small cell lung cancers, even for the medical condition of the patient who is suitable for lobectomy, 7,8 or segmentectomy may be an alternative to lobectomy in selected patients. 1,3,19,20 In a study by Yamato et al, 21 on histopathological subtype lung adenocarcinoma as in our study, 5-year survival was 87.5% in the segmentectomy group and 85.5% in the lobectomy group.…”

Section: Discussionmentioning

confidence: 99%

“…5 In parallel with developments in radiological imaging methods, increase in detection of small-sized lung tumors, especially adenocarcinoma histopathological type, 6 interest has increased in sublobar resections. 1,[7][8][9] Therefore, the role of segmentectomy in the surgical treatment of early non-small cell lung cancer has become controversial.…”

Section: Introductionmentioning

confidence: 99%

Is it Unjustified to Perform Segmentectomy in Surgical Treatment of Lung Adenocarcinoma?

2021

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Background:The aim of our study differs from similar studies since we compared superiority and similarity of segmentectomy performed for early-stage lung cancer over lobectomy in terms of clinical and oncological results. Methods: The data from 294 patients who underwent anatomical resection due to primary lung cancer were retrospectively reviewed. Data from 99 patients who underwent lobectomy and segmentectomy due to early-stage lung adenocarcinoma were analyzed. Patients were divided into two groups: 84 patients undergoing lobectomy and 15 patients undergoing segmentectomy. Both groups were analyzed in terms of epidemiological, surgical and oncological results, by comparing several parameters. Results: The most common postoperative complication was observed in the respiratory system. In total, 25 complication (29.8%) in the lobectomy group and 3 complications (20%) in the segmentectomy group were observed related to the postoperative respiratory system (P = 0.546). There was no statistically significant difference between the two groups in terms of recurrence-metastasis during follow-up, chemotherapy-radiotherapy condition and mortality. Main discharge time and thorax drain termination time were shorter in the segmentectomy group (P = 0.011 and P = 0.033, respectively). There was no statistically significant difference between the two groups in terms of postoperative survival or disease-free time (P = 0.361 and P = 0.461, respectively). Conclusion:If there is no contraindication, segmentectomy can be considered as the surgical treatment for lung adenocarcinomas with tumor size of 2 cm or less and a minimum 1 cm clean surgical margin.

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Wedge resection versus segmentectomy in patients with stage I non–small-cell lung cancer unfit for lobectomy

Cited by 24 publications

References 19 publications

Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching’s Study

Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching’s Study

Thermal Ablation Versus Wedge Resection for Stage I Non-small Cell Lung Cancer Based on the Eighth Edition of the TNM Classification: A Population Study of the US SEER Database

Is it Unjustified to Perform Segmentectomy in Surgical Treatment of Lung Adenocarcinoma?

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