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Clinical outcome of subcentimeter non-small cell lung cancer after VATS resection: Single institute experience with 424 patients. J Formos Med Assoc 2019; 119:399-405. [PMID: 31375390 DOI: 10.1016/j.jfma.2019.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/13/2019] [Accepted: 07/03/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/PURPOSE Non-small cell lung cancer (NSCLC) presenting as subcentimeter lung tumor was increasing due to the popularity of low dose CT in recent years. However, the ideal surgical management is still controversial. We utilized our lung cancer surgery database to study the important issue, aiming to find the optimal treatment with VATS. METHODS From January 2010 to December 2015, we retrospectively reviewed the clinical characteristics, staging, operation methods, and outcomes of 424 patients with subcentimeter lung cancer. Three groups distinguished by surgical methods were compared. RESULTS There are 273, 57, and 94 undergoing VATS wedge resection, segmentectomy, and lobectomy, respectively. Of the nine recurrence or metastasis events, seven and two occurred within the wedge resection and lobectomy groups, respectively. The average follow-up time is 779 days (2.16 years). Furthermore, 97.4%, 100%, and 97.9% of patients in the wedge resection, segmentectomy, and lobectomy groups, respectively remained tumor-free during follow-up. The complication rate of approximately 1.5% did not differ significantly between the three groups. An obvious difference in disease-free survival between the three groups (p-value = 0.027; -2 log likelihood score and chi-square test). No cases of recurrence or metastasis were observed in the segmentectomy group. CONCLUSION Lung cancer with subcentimeter size will be more and more encountered. VATS plays an important role in the management with good post-operative outcome, whether with wedge resection, segmentectomy and lobectomy. However, VATS segmentectomy can deliver 100% overall survival and progression-free survival in our series. Further randomized controlled trial should be conducted to prove the concept.
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Anraku M. The role of lymph node assessment along with sublobar resection is now evident, but what about the role of sublobar resection in small non-small cell lung cancer? J Thorac Dis 2019; 11:S1389-S1392. [PMID: 31245142 DOI: 10.21037/jtd.2019.03.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Masaki Anraku
- Division of Thoracic Surgery, JR Tokyo General Hospital, Tokyo, Japan.,Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Huang TW, Lin KH, Huang HK, Chen YI, Ko KH, Chang CK, Hsu HH, Chang H, Lee SC. The role of the ground-glass opacity ratio in resected lung adenocarcinoma. Eur J Cardiothorac Surg 2019; 54:229-234. [PMID: 29471517 DOI: 10.1093/ejcts/ezy040] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/04/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The goal of this study was to investigate the role of the ground-glass opacity (GGO) ratio in lung adenocarcinoma in predicting surgical outcomes. METHODS Patients who underwent surgical resection for pulmonary adenocarcinoma between January 2004 and December 2013 were reviewed. The clinical data, imaging characteristics of nodules, surgical approaches and outcomes were analysed with a mean follow-up of 87 months. RESULTS Of 789 enrolled patients, 267 cases were categorized as having a GGO ratio ≥0.75; 522 cases were categorized as having a GGO ratio <0.75. The gender, tumour differentiation, epidermal growth factor receptor mutation, smoking habits, lymphovascular space invasion, tumour size, maximum standard uptake value and carcinoembryonic antigen levels were significantly different in the 2 groups. In the group with a GGO ratio ≥0.75, 63.3% of the patients underwent sublobar resection (18.8% with a GGO ratio < 0.75, P <0.001). These patients had fewer relapses (2.2% for GGO ratio ≥0.75, 26.8% for GGO ratio <0.75, P < 0.001) and a better 5-year survival rate (95.5% for GGO ratio ≥0.75, 77.4% for GGO ratio <0.75, P < 0.001). None of the patients with a GGO ratio ≥0.75 had lymph node involvement. The multivariable Cox regression analysis revealed that a GGO ratio <0.75 was an independent factor for postoperative relapse with a hazard ratio of 3.96. CONCLUSIONS A GGO ratio ≥0.75 provided a favourable prognostic prediction in patients with resected lung adenocarcinoma. Sublobar resection and lymph node sampling revealed a fair outcome regardless of tumour size. However, anatomical resection is still the standard approach for patients with tumours with a GGO ratio <0.75, size >2 cm.
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Affiliation(s)
- Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuan-Hsun Lin
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsu-Kai Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-I Chen
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Hsiung Ko
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Kuang Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung Chang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Chun Lee
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Baldes N, Eberlein M, Bölükbas S. Early-stage non-small cell lung cancer: the required type of resection (lobar vs. sublobar) remains unanswered. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:191. [PMID: 31205909 DOI: 10.21037/atm.2019.03.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Natalie Baldes
- Department of Thoracic Surgery, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Michael Eberlein
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Servet Bölükbas
- Department of Thoracic Surgery, Evangelische Kliniken Essen-Mitte, Essen, Germany
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Long-Term Prognosis After Segmentectomy for cT1 N0 M0 Non-Small Cell Lung Cancer. Ann Thorac Surg 2019; 107:1500-1506. [DOI: 10.1016/j.athoracsur.2018.11.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/04/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022]
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Nie Y, Liu H, Tan X, Wang H, Li F, Li C, Han P, Lyv X, Xu X, Guo M. Correlation between high-resolution computed tomography lung nodule characteristics and EGFR mutation in lung adenocarcinomas. Onco Targets Ther 2019; 12:519-526. [PMID: 30666130 PMCID: PMC6330973 DOI: 10.2147/ott.s184217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to investigate the correlation of EGFR mutation on the high-resolution computed tomography (HRCT) features in lung adenocarcinoma. Patients and methods A total of 121 patients were diagnosed with lung adenocarcinoma from January 2014 to December 2016. The correlation of indexes (gender, age, tumor diameter, and EGFR mutation) was analyzed based on the HRCT characteristics of lung adenocarcinoma. Results There were 73 cases of EGFR mutation and 48 cases of wild-type EGFR. One hundred and three cases had pleural indentation that was significant in patients with EGFR mutation than those with wild-type EGFR (P=0.038). Forty-two out of 121 cases exhibited the bronchus cutoff sign. Patients with EGFR mutation were likely to develop the bronchus cutoff sign (P=0.017). Sixty-one out of 121 cases exhibited the lobulation sign, which was significant in patients with EGFR mutation than those with wild-type EGFR (P<0.001). A significant correlation was found between lobulation sign and tumor diameter (P=0.024). Forty-eight out of 121 and 23 out of 121 cases showed the vessel and vacuole signs, respectively. However, patients with EGFR mutation did not exert a significant correlation on either of these signs (P=0.555 and P=0.372, respectively). A statistical significance was not observed in indexes such as age, gender, and tumor diameter on pleural indentation, bronchus cutoff sign, vessel sign, and vacuole sign (P>0.05). Age and gender did not vary significantly in the lobulation sign (P>0.05). Conclusion HRCT characteristics such as pleural indentation, bronchus cutoff sign, and lobulation sign in lung adenocarcinoma with EGFR mutation were significantly greater than those with wild-type EGFR; however, further study is essential in determining the predictive ability of computed tomography (CT) for EGFR mutations in lung adenocarcinoma.
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Affiliation(s)
- Yunqiang Nie
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, China
| | - Hongjun Liu
- Department of Internal Medicine, 120 Emergency Command Center of Linyi City, Linyi 276002, China
| | - Xiao Tan
- Department of Pathology, Linyi People's Hospital, Linyi 276000, China
| | - Hui Wang
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, China
| | - Fuzhou Li
- Department of Radiology, Linyi People's Hospital, Linyi 276000, China
| | - Cuiyun Li
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, China
| | - Ping Han
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, China
| | - Xin Lyv
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, China
| | - Xinyi Xu
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi 276000, China
| | - Miao Guo
- Department of Geriatrics, Linyi People's Hospital, Linyi 276000, China,
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Zhang WH, Bai YY, Guo W, Li M, Chang GX, Liu W, Mao Y. Application of intrapulmonary wire combined with intrapleural fibrin glue in preoperative localization of small pulmonary nodules. Medicine (Baltimore) 2019; 98:e14029. [PMID: 30681559 PMCID: PMC6358377 DOI: 10.1097/md.0000000000014029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to investigate the accuracy of the preoperative localization of small nodules by computerized tomography (CT)-guided placing wire and intrapleural fibrin glue near the nodules at 3 days before the operation. METHODS From October 2015 to December 2017, a total of 79 patients, who received preoperative localization of small pulmonary nodules and surgical treatment in the Department of Thoracic Surgery of Hohhot First Hospital, were enrolled into this study. These patients were randomly divided into 2 groups: methylene blue localization group (n = 47), and modified localization group (n = 32), where the patients received preoperative localization of the small nodules by CT-guided placing wire and intrapleural fibrin glue near the nodule at 3 days before the operation. Localization accuracy, operation time and difficulty in postoperative seeking for pathological specimens were compared between these 2 groups. RESULTS In the methylene blue localization group, 3 patients had localization failure due to the intrathoracic diffusion of methylene blue, and the success rate was 93.61%. In the modified localization group, all 32 patients succeeded in the localization, and the success rate was 100%. Operation time and difficulty of finding the specimen was significantly lower in the modified localization group than in the methylene blue localization group (P < .05). CONCLUSION The application of preoperative localization of small nodules by placing wire and intrapleural fibrin glue improves the success rate of resection, reduces operation time and the risk of the operation, and lowers the difficulty of finding pathological specimens after the operation. Hence this operative procedure is worthy of popularization.
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Affiliation(s)
- Wen-Hua Zhang
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Yan-Yan Bai
- Department of Anesthesiology, The First Hospital of Hohhot, Inner Mongolia, China
| | - Wei Guo
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Ming Li
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Gui-Xia Chang
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Wei Liu
- Department of Thoracic Surgery, The First Hospital of Hohhot
| | - Yu Mao
- Department of Thoracic Surgery, The First Hospital of Hohhot
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Yang H, Li X, Shi J, Fu H, Yang H, Liang Z, Xiong H, Wang H. A nomogram to predict prognosis in patients undergoing sublobar resection for stage IA non-small-cell lung cancer. Cancer Manag Res 2018; 10:6611-6626. [PMID: 30584357 PMCID: PMC6284539 DOI: 10.2147/cmar.s182458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction This study aimed to develop a practical nomogram to predict prognosis in patients who are undergoing sublobar resection for stage IA non-small-cell lung cancer (NSCLC). Data from Surveillance, Epidemiology, and End Results (SEER) databases were used to construct the nomogram. Methods Data from patients undergoing sublobar resection for stage IA NSCLC diagnosed between 2004 and 2014 were extracted from the SEER database. Factors that may predict the outcome were identified using the Kaplan–Meier method and the Cox proportional-hazards model. A nomogram was constructed to predict the 3- and 5-year overall survival (OS) and lung cancer-specific survival (LCSS) rates of these patients. The predictive accuracy of the nomogram was measured using the concordance index (C-index) and calibration curve. Results A total of 4,866 patients were selected for this study. Using univariate and multivariate analyses, eight independent prognostic factors associated with OS were identified, including sex (P<0.001), age (P<0.001), race (P=0.043), marital status (P=0.009), pathology (P=0.004), differentiation (P<0.001), tumor size (P<0.001), and surgery (P=0.001), and five independent prognostic factors associated with LCSS were also identified, including sex (P<0.001), age (P<0.001), differentiation (P<0.001), tumor size (P<0.001), and surgery (P=0.011). A nomogram was established based on these results and validated using the internal bootstrap resampling method. The C-index of the established nomogram for OS and LCSS was 0.649 (95% CI: 0.635–0.663) and 0.640 (95% CI: 0.622–0.658), respectively. The calibration curves for probability of 3-, and 5-year OS and LCSS rates demonstrated good agreement between the nomogram prediction and actual observation. Conclusion This innovative nomogram delivered a relatively accurate individual prognostic prediction for patients undergoing sublobar resection for stage IA NSCLC.
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Affiliation(s)
- Heli Yang
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Xiangdong Li
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, People's Republic of China
| | - Jialun Shi
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, People's Republic of China
| | - Hao Fu
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Hao Yang
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, People's Republic of China
| | - Zhen Liang
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Hongchao Xiong
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Hui Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China,
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Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). THE LANCET RESPIRATORY MEDICINE 2018; 6:915-924. [PMID: 30442588 DOI: 10.1016/s2213-2600(18)30411-9] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/11/2018] [Accepted: 09/27/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increased detection of small-sized, peripheral, non-small-cell lung cancer has renewed interest in sublobar resection instead of lobectomy, the traditional standard of care for early-stage lung cancer. We aimed to assess morbidity and mortality associated with lobar and sublobar resection for early-stage lung cancer. METHODS CALGB/Alliance 140503 is a multicentre, international, non-inferiority, phase 3 trial in patients with peripheral non-small-cell lung cancer clinically staged as T1aN0. Patients were recruited from 69 academic and community-based institutions in Australia, Canada, and the USA. Patients were randomly assigned intraoperatively to either lobar or sublobar resection. The random assignment was based on permuted block randomisation without concealment and was stratified according to radiographic tumour size, histology, and smoking status. The primary endpoint of the trial is disease-free survival; here, we report a post-hoc, exploratory, comparative analysis of perioperative mortality and morbidity associated with lobar and sublobar resection. Perioperative mortality was defined as death from any cause within 30 days and 90 days of surgical intervention and was calculated for all randomised patients. Morbidity was graded using Common Terminology Criteria for Adverse Events version 4.0. All analyses were done on an intention-to-treat basis for randomised patients with data available. This trial is registered with ClinicalTrials.gov, number NCT00499330. FINDINGS Between June 15, 2007, and March 13, 2017, 697 patients were randomly allocated to either lobar resection (n=357) or sublobar resection (n=340; 59% wedge resection). Six (0·9%) patients died by 30 days, four (1·1%) after lobar resection and two (0·6%) after sublobar resection; by 90 days, ten (1·4%) patients had died, six (1·7%) after lobar resection and four (1·2%) after sublobar resection (difference at 30 days, 0·5%, 95% CI -1·1 to 2·3; difference at 90 days, 0·5%, 95% CI -1·5 to 2·6). An adverse event of any grade occurred in 193 (54%) of 355 patients after lobar resection and 172 (51%) of 337 patients after sublobar resection. Adverse events of grade 3 or worse occurred in 54 (15%) patients assigned lobar resection and in 48 (14%) patients assigned sublobar resection. No differences between surgical approaches were noted in cardiac or pulmonary complications. Grade 3 haemorrhage (requiring transfusion) occurred in six (2%) patients assigned lobar resection and eight (2%) patients assigned sublobar resection. Prolonged air leak occurred in nine (3%) patients after lobar resection and two (1%) patients after sublobar resection. INTERPRETATION Our post-hoc analysis showed that perioperative mortality and morbidity did not seem to differ between lobar and sublobar resection in physically and functionally fit patients with clinical T1aN0 non-small-cell lung cancer. These data may affect the daily choices made by patients and their doctors in establishing the best treatment approach for stage I lung cancer. FUNDING National Cancer Institute.
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Zhang Z, Feng H, Xiao F, Liu D. Limited resection in clinical stage I non-small cell lung cancer patients aged 75 years old or more: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:359. [PMID: 30370286 DOI: 10.21037/atm.2018.08.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to compare perioperative and oncologic efficacy of limited resection with lobectomy in clinical stage I non-small cell lung cancer (NSCLC) patients ≥75 years old. Methods A systemic search of database including PubMed, OVID and Cochrane was carried out to identify the potential relevant studies published. Data extracted were analyzed with Revman 5.1. Results 5,304 citations were identified by the electronically search. A total of 3,461 patients were included, of whom 1,323 received limited resection and 2,139 received lobectomy. There was higher postoperative complication ratio after lobectomy (32.93% vs. 23.87%, RR =0.71; 95% CI, 0.54-0.93; P=0.01). There were similar total recurrent (18.56%, RR =1.15; 95% CI, 0.82-1.61; P=0.43), and distant recurrent ratio (16.17%, RR =0.67; 95% CI, 0.43-1.05; P=0.08) between groups. Lower local-regional recurrent ratio (2.40%, RR =4.31; 95% CI, 1.98-9.39; P<0.001) was observed after lobectomy. Compared with lobectomy, patients received limited resection showed poorer overall survival (HR =1.24; 95% CI, 1.07-1.44; P=0.004) and lung cancer specific survival (HR =1.37; 95% CI, 1.14-1.64; P<0.001). Conclusions This analysis showed superior lung cancer specific survival, and overall survival after lobectomy over limited resection for clinical stage I NSCLC patients aged ≥75 years old. Our results confirmed that lobectomy should be considered in aged patients if tolerable.
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Affiliation(s)
- Zhenrong Zhang
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hongxiang Feng
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fei Xiao
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
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Prediction of Occult Lymph Node Metastasis Using Tumor-to-Blood Standardized Uptake Ratio and Metabolic Parameters in Clinical N0 Lung Adenocarcinoma. Clin Nucl Med 2018; 43:715-720. [PMID: 30106864 DOI: 10.1097/rlu.0000000000002229] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE We aimed to investigate whether the tumor-to-blood SUV ratio (SUR) and metabolic parameters of F-FDG uptake could predict occult lymph node metastasis (OLM) in clinically node-negative (cN0) lung adenocarcinoma. MATERIALS AND METHODS We retrospectively reviewed 157 patients with cN0 lung adenocarcinoma who underwent both preoperative F-FDG PET/CT and surgical resection with the systematic lymph node dissection. The SUVmax, SUVmean, MTV, and total lesion glycolysis (TLG) of the primary tumor was measured on the PET/CT workstation. SURmax, SURmean, and TLGsur were derived from each of them divided by descending aorta SUVmean. These PET parameters and clinicopathological variables were analyzed for OLM. RESULTS In our study, OLM was detected in 31 (19.7%) of 157 patients. Significantly higher values of tumor size, SUVmax, SUVmean, MTV, TLGsuv, SURmax, SURmean, and TLGsur were found in patients with OLM. In receiver operating characteristic curve analysis, the optimal cutoff values of the above parameters were 29.50, 4.38, 2.45, 6.37, 44.13, 5.30, 1.86, and 28.24, respectively. The multivariate analysis showed that TLGsur (odds ratio, 1.024; P = 0.002) was the most potent associated factor for the prediction of OLM in cN0 lung adenocarcinoma. CONCLUSIONS TLGsur showed the most powerful predictive performance than the other PET parameters for the prediction of OLM in cN0 lung adenocarcinoma. This normalized volumetric parameter would be helpful in selection of sublobar resection or aggressive tailored treatments in patients with cN0 lung adenocarcinoma.
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Harrison S, Stiles B, Altorki N. What is the role of wedge resection for T1a lung cancer? J Thorac Dis 2018; 10:S1157-S1162. [PMID: 29785289 DOI: 10.21037/jtd.2018.03.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since 1995, lobar resection became the standard of care for medically fit patients with early stage lung cancer. This was based on the results of a single randomized trial comparing lobectomy and sublobar resection (SLR) in stage I lung cancer conducted by the lung cancer study group between 1982 and 1988. The conclusions of the study included a statistically significant tripling in loco-regional recurrence (LR) after limited resection but no difference between the two arms of the trial in systemic recurrence. Although both overall survival and cancer specific survival favored lobectomy, neither achieved statistical significance. Regardless, this landmark trial established lobectomy as the preferred oncological resection for early stage lung cancer. The practice of thoracic surgery has evolved significantly since the study period of the Lung Cancer Study Group, and this has led some surgeons to question its relevance to contemporary practice. The increased detection of smaller more precisely staged tumors combined with the rising segment of the population that is elderly with limited cardiopulmonary reserve has renewed interest in sub-lobar resection including wedge resection as either a definitive therapeutic strategy or as a compromise approach in patients with poor performance status. The interest in wedge resections is also to some extent further fueled by the emergence and increased utilization of competing technologies of local control such as stereotactic radiation or percutaneous and trans-bronchial ablative techniques. Although the results of the LCSG still cast a long shadow over the soundness of wedge resection as a cancer operation, much literature has been published in the subsequent years on this topic. We present in this review an overview of the conflicting data and offer our perspective on the role of wedge resection in early stage lung cancer.
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Affiliation(s)
- Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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Dong S, Zhang L. [Progress of Sublobectomy for the Treatment of Stage I Non-small Cell Lung Cancer in the Elderly]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 20:710-714. [PMID: 29061219 PMCID: PMC5972990 DOI: 10.3779/j.issn.1009-3419.2017.10.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
肺癌是世界范围内发病率最高的恶性肿瘤,且有逐年增加的趋势,随着人口老龄化和薄层电子计算机断层扫描(computed tomography, CT)的应用,老年早期肺癌被越来越多的发现,手术仍然是这类人群的主要治疗方式,目前主要手术方式为肺叶切除和亚肺叶切除两种,由于老年群体的特殊性,对手术方式的选择也趋于“个性化”,本文对这两种手术方式的选择问题做一综述。
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Affiliation(s)
- Siyuan Dong
- Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang 110001, China
| | - Lin Zhang
- Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang 110001, China
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Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology 2018; 23:695-703. [PMID: 29465766 DOI: 10.1111/resp.13277] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/13/2017] [Accepted: 01/24/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Standard surgical management for early stage lung cancer is lobectomy with mediastinal lymph node dissection. The feasibility of limited resection remains controversial; we retrospectively assessed lung cancer-specific survival (LCSS) and overall survival (OS) in early stage non-small cell lung cancer (NSCLC) to evaluate whether segmentectomy is comparable to standard lobectomy. METHODS Patients with primary NSCLC of 20 mm or less who were diagnosed from 2000 to 2014 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. To compare the two surgical interventions, a propensity score analysis was performed between lobectomy and segmentectomy. RESULTS Of the 15 358 patients analysed, there were 14 549 lobectomies and 809 segmentectomies. The 5-year OS was 76% for the lobectomy group and 74.4% for the segmentectomy group. There were no significant differences in OS or LCSS among patients who underwent lobectomy versus segmentectomy, as demonstrated by the propensity-matched hazard ratio (HR) for OS (HR: 1.195, 95% CI: 0.993-1.439) and LCSS (HR: 1.124, 95% CI: 0.860-1.469). The inverse propensity-weighted analysis also supported these results. Segmentectomy was more likely to be performed in elderly patients. In the subset of patients aged ≥75 years, the segmentectomy group demonstrated comparable OS (HR: 1.17, 95% CI: 0.87-1.58, P = 0.31) and LCSS (HR: 0.94, 95% CI: 0.59-1.51, P = 0.81), compared with the lobectomy group. CONCLUSION Equivalent OS and LCSS were demonstrated in patients with primary NSCLC of 20 mm or less without lymph node or distant metastasis.
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Affiliation(s)
- Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
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Asamura H, Aokage K, Yotsukura M. Wedge Resection Versus Anatomic Resection: Extent of Surgical Resection for Stage I and II Lung Cancer. Am Soc Clin Oncol Educ Book 2017; 37:426-433. [PMID: 28561723 DOI: 10.1200/edbk_179730] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Currently, surgery for lung cancer with curative intent consists of resection (removal) of the proper extent of lung parenchyma that bears the cancer lesion along with locoregional lymph nodes to assess possible cancer metastasis. Lobectomy, at least, is preferred with regard to the extent of parenchymal resection. The history of lung cancer surgery, which started around 1933 as pneumonectomy (resection of the entire lung on either side), can be characterized as an attempt to minimize the extent of parenchymal resection. In the early 1960s, pneumonectomy was replaced by lobectomy, which has long been respected as the standard surgical mode. However, the transition from lobectomy to a lesser resection, such as segmentectomy or wedge resection, was not recommended because of the results of a randomized trial performed by the North American Lung Cancer Study Group in the 1980s. As of now, the extent of parenchymal resection remains lobectomy, and lesser resection is indicated only for patients who have a compromised pulmonary reserve. Very recently, because of the advent of CT screening programs and improvements in imaging technology, fainter and smaller lung cancers are being discovered. For these smaller and earlier lung cancers, there is some uncertainty about whether lobectomy still should be indicated, as it is for larger tumors with a diameter of 3 cm or more. Therefore, several randomized trials are ongoing to compare lobectomy with lesser resections; endpoints are overall survival and postoperative pulmonary function. Until the results of these trials are available, lung cancer should still be removed by lobectomy rather than by limited resection, such as segmentectomy or wedge resection.
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Affiliation(s)
- Hisao Asamura
- From the Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan; Keio University School of Medicine, Tokyo, Japan
| | - Keiju Aokage
- From the Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan; Keio University School of Medicine, Tokyo, Japan
| | - Masaya Yotsukura
- From the Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan; Keio University School of Medicine, Tokyo, Japan
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66
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Qu X, Wang K, Zhang T, Shen H, Dong W, Liu Q, Du J. Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis. J Thorac Dis 2017; 9:4561-4573. [PMID: 29268526 DOI: 10.21037/jtd.2017.10.129] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Segmentectomy has the advantage of less complications, but might have less lymph node sampling and higher risk of recurrence. We aimed to compare treatment outcome between two surgical options, and explore the effect of regional lymph node removal on the prognostic difference. Methods We retrospectively analyzed data of stage I non-small cell lung cancer (NSCLC) (≤3 cm in size) patients who underwent either segmentectomy, or lobectomy, collected from the Surveillance, Epidemiology and End Results (SEER) database, from 2003 to 2013. The primary endpoints were overall survival (OS) and lung cancer-specific survival (LCSS). We also collected data from Shandong Provincial Hospital as validation. Results Ultimately 1,156 patients treated by segmentectomy and 17,748 patients treated by lobectomy from SEER database were included in the analysis. Overall, segmentectomy was inferior to lobectomy in terms of OS [hazard ratio (HR): 1.316 (1.186-1.461), P<0.001] and LCSS [HR: 1.310 (1.142-1.504), P<0.001]. When the removal of regional lymph nodes (LN) was taken into consideration, no significant difference was found in OS and LCSS, in any Scope of Regional Lymph Node Surgery layer (0, 1-3, more than 3, and biopsy/sentinel layer, all P>0.05). After propensity score matching (PSM), there was no difference between segmentectomy and lobectomy in OS [HR: 1.081 (0.937-1.248), P=0.286] and LCSS [HR: 1.039 (0.861-1.253), P=0.692]. Only sex, age, histology, summary stage, differentiation, tumor size, and radiation still remained as independent prognostic factors for both OS and LCSS. For validation part, there was no significantly prognostic difference between lobectomy and sublobectomy group in overall (P=0.132) and each regional LN removed layer (0, 1-3, more than 3 layers: all P>0.05). Conclusions Segmentectomy with proper lymph node resection or sampling could be a good alternative to lobectomy.
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Affiliation(s)
- Xiao Qu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Kai Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,Department of Healthcare Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Tiehong Zhang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Hongchang Shen
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Wei Dong
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Qi Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Ma Q, Bao T, Zhang H, Liang C, Liu D. Anatomical video-assisted thoracoscopic surgery segmentectomies based on the three-dimensional reformation images. J Vis Surg 2017; 3:21. [PMID: 29078584 DOI: 10.21037/jovs.2017.02.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/06/2022]
Abstract
Segmentectomy was first done in 1939 by Churchill and Belsey in 1939. Video-assisted thoracoscopic surgery (VATS) segmentectomies are still more technically challenging than VATS lobectomies. With the increasing rate of early stage lung carcinomas, the thoracoscopic segmentectomies may have a major role in a near future. Four anatomical VATS segmentectomy videos clips were shared in this study. CT three-dimensional reformation could exactly show the small pulmonary nodule's precise position, clarifies the surrounding structures' relationship like the pulmonary artery (PA), pulmonary vein (PV), bronchus (B), fissure, and lymph nodes. Besides, the resection margin, skin incision, surgical approach can also be designed preoperatively. This feasible technique could increase the confidence for thoracic surgeons. Unnecessary explore time waste for locating small pulmonary nodules during the operation can be avoid, so the surgical accuracy can be improved, complications can be prevented, the duration of chest tube and length of hospital stay can be shortened.
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Affiliation(s)
- Qianli Ma
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Tong Bao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Haitao Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Abstract
Advancements in the diagnosis, staging and management of lung cancer have all led to improvements in outcomes associated with sublobar resection. Lobectomy, for early stage lung cancers has been the treatment of choice for many years. However, there is mounting evidence that sublobar resection when applied to the appropriate patient population can provide not only excellent oncologic results but also equivalent survival to lobectomy. Therefore, it is time that we reevaluate the management of peripheral stage IA lung cancers.
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Affiliation(s)
- Kathleen S Berfield
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Douglas E Wood
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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Wang J, Zhao H. [Issues Need to be Considered in Sublobectomy for Early Stage Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:351-4. [PMID: 27335295 PMCID: PMC6015199 DOI: 10.3779/j.issn.1009-3419.2016.06.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
随着医学技术的进步,早期肺癌患者数量逐年增加,亚肺叶切除治疗在早期肺癌个体化治疗的价值逐渐受到重视。目前,在早期肺癌的术式选择上,肺叶切除和亚肺叶切除孰优孰劣尚存在一些争议。本文就当前亚肺叶切除治疗早期肺癌的下述争议点进行了总结:①循证医学证据;②楔形和肺段的适应症选择;③肿瘤直径和切缘距离的权重比较;④老年人的术式选择。
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Affiliation(s)
- Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Hui Zhao
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
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High Risk for Thoracotomy but not Thoracoscopic Lobectomy. Ann Thorac Surg 2017; 103:1730-1735. [PMID: 28262299 DOI: 10.1016/j.athoracsur.2016.11.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/21/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pulmonary lobectomy is the standard of care for resection of non-small cell lung cancer (NSCLC). Patients with compromised lung function who are considered high risk may be denied surgical treatment; thus, proper identification of those truly at high risk is critical. Video-assisted thoracic surgery (VATS) may reduce the operative risk. This study reviews our institutional experience of pulmonary lobectomy by open thoracotomy or VATS techniques in patients deemed to be high risk. METHODS A retrospective review of an institutional database was performed for all patients undergoing lobectomy from 2002 to 2010. Patients were grouped into high-risk (HR) and standard-risk (SR) cohorts according to the American College of Surgeons Oncology Group Z4099/Radiation Therapy Oncology Group 1021 criteria. RESULTS From 2002 to 2010, 72 HR and 536 SR patients underwent lobectomy. Mean age was 73 years for HR and 66 years for SR (p < 0.0001). Rates of overall (p < 0.0001) and pulmonary complications (p < 0.0001) were significantly higher in the HR group. However, when HR patients were resected by VATS, there was no significant difference in overall (p = 0.1299) or pulmonary complications (p = 0.2292) compared with the SR VATS group. Moreover, overall survival was significantly lower for HR patients who had an open operation compared with VATS lobectomy or SR open (p = 0.0028). CONCLUSIONS VATS lobectomy offers patients who are considered to be at increased risk for open lobectomy a feasible procedure, with no difference in overall survival compared with SR patients, and decreased morbidity compared with open lobectomy. VATS lobectomy should be considered for patients who historically may not have been considered for surgical resection.
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71
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Survival following segmentectomy or lobectomy in elderly patients with early-stage lung cancer. Oncotarget 2017; 7:19081-6. [PMID: 26934652 PMCID: PMC4951354 DOI: 10.18632/oncotarget.7704] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/06/2015] [Indexed: 12/01/2022] Open
Abstract
Purpose To determine the survival following segmentectomy versus lobectomy in elderly patients with early-stage non-small cell lung cancer (NSCLC). Methods We identified 12324 elderly (≥ 70 years) patients with stage I ≤ 3 cm NSCLC in the Surveillance, Epidemiology and End Results (SEER) database. Propensity score methods were used to balance baseline characteristics of patients undergoing segmentectomy or lobectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) of patients treated with segmentectomy versus lobectomy were compared in Cox regression models after adjusting, stratifying or matching patients based on propensity scores. Results Cox models adjusting, stratifying or matching propensity scores all showed that patients treated with segmentectomy had significantly worse OS and LCSS compared to lobectomy. Subgroup analysis of patients with tumors ≤ 2cm, aged ≥ 75 years, or had ≥ 7 lymph nodes examined also revealed survival advantage associated with lobectomy. Conclusion Elder age alone could not justify the application of segmentectomy in early-stage lung cancer. Prospective randomized trials are warranted to validate our results.
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Rami-Porta R. Tiny lung adenocarcinomas: better prognosis with a word of caution. J Thorac Dis 2016; 8:E1075-E1078. [PMID: 27747068 DOI: 10.21037/jtd.2016.07.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; ; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
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Survival After Sublobar Resection Versus Lobectomy for Clinical Stage IA Lung Cancer: Analysis From the National Cancer Database. J Thorac Oncol 2016; 10:1513-4. [PMID: 26536192 DOI: 10.1097/jto.0000000000000674] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dai C, Shen J, Ren Y, Zhong S, Zheng H, He J, Xie D, Fei K, Liang W, Jiang G, Yang P, Petersen RH, Ng CS, Liu CC, Rocco G, Brunelli A, Shen Y, Chen C, He J. Choice of Surgical Procedure for Patients With Non–Small-Cell Lung Cancer ≤ 1 cm or > 1 to 2 cm Among Lobectomy, Segmentectomy, and Wedge Resection: A Population-Based Study. J Clin Oncol 2016; 34:3175-82. [PMID: 27382092 DOI: 10.1200/jco.2015.64.6729] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose According to the lung cancer staging project, T1a (≤ 2 cm) non–small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. Methods We identified 15,760 patients with T1aN0M0 NSCLC after surgery from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and lung cancer–specific survival (LCSS) were compared among patients after lobectomy, segmentectomy, or wedge resection. The proportional hazards model was applied to evaluate multiple prognostic factors. Results OS and LCSS favored lobectomy compared with segmentectomy or wedge resection in patients with NSCLC ≤ 1 cm and > 1 to 2 cm. Multivariable analysis showed that segmentectomy and wedge resection were independently associated with poorer OS and LCSS than lobectomy for NSCLC ≤ 1 cm and > 1 to 2 cm. With sublobar resection, lower OS and LCSS emerged for NSCLC > 1 to 2 cm after wedge resection, whereas similar survivals were observed for NSCLC ≤ 1 cm. Multivariable analyses showed that wedge resection is an independent risk factor of survival for NSCLC > 1 to 2 cm but not for NSCLC ≤ 1 cm. Conclusion Lobectomy showed better survival than sublobar resection for patients with NSCLC ≤ 1 cm and > 1 to 2 cm. For patients in whom lobectomy is unsuitable, segmentectomy should be recommended for NSCLC > 1 to 2 cm, whereas surgeons could rely on surgical skills and the patient profile to decide between segmentectomy and wedge resection for NSCLC ≤ 1 cm.
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Affiliation(s)
- Chenyang Dai
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Jianfei Shen
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Yijiu Ren
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Shengyi Zhong
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Hui Zheng
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Jiaxi He
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Dong Xie
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Ke Fei
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Wenhua Liang
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Gening Jiang
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Ping Yang
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Rene Horsleben Petersen
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Calvin S.H. Ng
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Chia-Chuan Liu
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Gaetano Rocco
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Alessandro Brunelli
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Yaxing Shen
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Chang Chen
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
| | - Jianxing He
- Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Ping Yang, Mayo Clinic College of Medicine,
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Liu D, Zhang Z. [Issues Relevant to Surgical Intervention in 'Tiny' Non-small Cell Lung Cancer Detected by 'Lung Screening'--Orientation, Lung Resection and Lymph Node Resection]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:347-50. [PMID: 27335294 PMCID: PMC6015196 DOI: 10.3779/j.issn.1009-3419.2016.06.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
随着胸部计算机断层扫描(computed tomography, CT)的广泛应用,以及肺癌高危人群筛查的逐渐开展,越来越多的“小肺癌”被发现及诊断。“小肺癌”具有的术中定位困难、侵袭性弱、近期和远期预后较好的特点为肺癌的外科治疗提出了新的挑战,本文着重从肺癌的筛查、小结节定位、肺叶切除与亚肺叶切除以及淋巴结清扫范围等方面对“小肺癌”带来的挑战进行探讨。
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Affiliation(s)
- Deruo Liu
- Department of Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
| | - Zhenrong Zhang
- Department of Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
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Yang F, Sui X, Chen X, Zhang L, Wang X, Wang S, Wang J. Sublobar resection versus lobectomy in Surgical Treatment of Elderly Patients with early-stage non-small cell lung cancer (STEPS): study protocol for a randomized controlled trial. Trials 2016; 17:191. [PMID: 27053091 PMCID: PMC4823889 DOI: 10.1186/s13063-016-1312-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 03/23/2016] [Indexed: 12/25/2022] Open
Abstract
Background The appropriateness of lobectomy for all elderly patients is controversial. Meanwhile, sublobar resection is associated with reduced operative risk, better preservation of pulmonary function, and a better quality of life, constituting a potential alternative to standard lobectomy for elderly patients with early-stage non-small cell lung cancer (NSCLC). To date, no randomized trial comparing sublobar resection and lobectomy focusing on elderly patients has been reported. We hypothesized that for patients at least 70 years old with clinical stage T1N0M0 NSCLC, sublobar resection is non-inferior to lobectomy for 3-year disease-free survival (DFS). Methods/design This is a prospective, randomized, controlled multicenter non-inferiority trial with two study arms: sublobar resection and lobectomy groups. Comprehensive geriatric assessments will be acquired for each patient. A total of 339 subjects will be enrolled on the basis of power calculations, and participants followed up every 6 months post-operation for 3 years. In case of relapse, survival follow-up will be continued until 5 years or death. Pulmonary function testing will be performed at 6, 12, and 36 months post-operation. The primary outcome is 3-year DFS; secondary endpoints include peri-operative complications and mortality, hospitalization time, post-operative ventilator time, overall survival, 3-year recurrence rates, post-operative pulmonary function, quality of life, geriatric assessment data, and 4-year mortality index. Discussion The present study is the only prospective, multicenter, randomized controlled trial comparing sublobar resection and lobectomy for elderly patients. The therapeutic outcomes of sublobar resection will be evaluated in comparison with lobectomy for elderly patients (≥70 years) with early-stage NSCLC. Trial registration number NCT02360761: 01/24/2015 (ClinicalTrials.gov)
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Affiliation(s)
- Fan Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China.
| | - Xiuyuan Chen
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Lixue Zhang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Xun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
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78
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Ma Q, Liu D. Video-assisted thoracic surgery experience of calcified lymph nodes for lingular sparing lobectomy. J Vis Surg 2016; 2:46. [PMID: 29078474 DOI: 10.21037/jovs.2016.02.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/21/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is commonly used for posterior, superior and lingular segmentectomy. Segmental resections involving the left upper lobe are the following: upper division (S1+2 and S3) (lingular sparing lobectomy), apicoposterior segmentectomy (S1 + S2), and lingulectomy (S4 + S5). Lingular sparing lobectomy is still a challenge for more technical demanding and more anatomic variations, especially when facing calcified lymph nodes. METHODS A 73 years old woman was admitted for founding a ground glass opacity (GGO) during the screening test (1.0 cm × 1.0 cm). Her pulmonary function result was forced expiratory volume in 1 second (FEV1): 1.51 L (54.7% predicted). She was a non-smoker, with negative bronchoscopy findings. She received general anesthesia with double-lumen endotracheal intubation and right lung ventilation. Right lateral decubitus position was chosen. The first 1.5-cm incision was selected in the 8th intercostal space in the midaxillary line, and was used for the camera. A 4-cm long incision was made in the 4th intercostal space in the preaxillary line. A third 1.5-cm incision was performed in the 9th intercostal space in the postaxillary line for assistant. Pulmonary ligament and the entire left hilum were mobilized. The superior pulmonary vein has usually three major tributaries. The superior branch drains the apicoposterior segments and frequently blocks the access to the apicoposterior arteries. The middle branch drains the anterior segment, and the lowermost branch drains the lingula. The lingular vein must be preserved. The apicoposterior and anterior segment vein was transected with a vascular stapler. Anterior pulmonary artery and anterior bronchus were then divided and stapled. The upper lobe bronchus splits immediately into the lingular bronchus and a common stem. All these segmental bronchi have short course and a calcified lymph node located between the apicoposterior pulmonary artery and apicoposterior bronchus. These situations make the dissection and identification very difficult. Following many failure attempts of trying take the calcified lymph node out. Staple the left apicoposterior pulmonary artery together with the apicoposterior bronchi is completed. And left upper division (S1+2 and S3) was taken out after stapling lung tissue above the level of lingular segment with a 60-mm green linear stapler. Mediastinal lymph nodes of level 9, 7, 4L and 5 were cleared afterwards. RESULTS Pathology was confirmed with adenocarcinoma (ancinar component dominant). There were no complications and the patient was discharged 6 days postoperatively. CONCLUSIONS Staple the left apicoposterior pulmonary artery together with the apicoposterior bronchi is a safe and feasible way when facing the difficult dissection of the calcified lymph nodes during segmentectomy.
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Affiliation(s)
- Qianli Ma
- Department of Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
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Gulack BC, Yang CFJ, Speicher PJ, Meza JM, Gu L, Wang X, D'Amico TA, Hartwig MG, Berry MF. The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer. Lung Cancer 2015; 90:554-60. [PMID: 26519122 DOI: 10.1016/j.lungcan.2015.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/04/2015] [Accepted: 10/05/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Lymph node evaluation for node-negative non-small cell lung cancer (NSCLC) is associated with long-term survival but it is not clear if smaller tumors require as extensive a pathologic nodal assessment as larger tumors. This study evaluated the relationship of tumor size and optimal extent of lymph node resection using the National Cancer Data Base (NCDB). MATERIALS AND METHODS The incremental survival benefit of each additional lymph node that was evaluated for patients in the NCDB who underwent lobectomy for clinical Stage I NSCLC from 2003 to 2006 was evaluated using Cox multivariable proportional hazards regression modeling. The impact of tumor size was assessed by repeating the Cox analysis with patients stratified by tumor size ≥2 cm vs <2 cm. RESULTS A median of 7 [interquartile range: 4,11] lymph nodes were examined in 13,827 patients who met study criteria. Following adjustment, the evaluation of each additional lymph node demonstrated a significant survival benefit through 11 lymph nodes. After grouping patients by tumor size, patients with tumors <2 cm demonstrated a significant survival benefit for the incremental resection of each additional lymph node through 4 lymph nodes while patients with tumors ≥2 cm had a significant survival benefit through 14 lymph nodes. CONCLUSION Pathologic lymph node evaluation is associated with improved survival for clinically node-negative NSCLC, but the extent of the necessary evaluation varies by tumor size. These results have implications for guidelines for lymph node assessment as well as the choice of surgery vs other ablative techniques for clinical stage I NSCLC.
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Affiliation(s)
- Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - James M Meza
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Lin Gu
- Department of Biostatistics, Duke University Medical Center, Durham, NC, United States
| | - Xiaofei Wang
- Department of Biostatistics, Duke University Medical Center, Durham, NC, United States
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Matthew G Hartwig
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States.
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Speicher PJ, Gu L, Gulack BC, Wang X, D'Amico TA, Hartwig MG, Berry MF. Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States. Clin Lung Cancer 2015; 17:47-55. [PMID: 26602547 DOI: 10.1016/j.cllc.2015.07.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/19/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study evaluated the use of lobectomy and sublobar resection for clinical stage IA non-small-cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB). METHODS The NCDB from 2003 to 2011 was analyzed to determine factors associated with the use of a sublobar resection versus a lobectomy for the treatment of clinical stage IA NSCLC. Overall survival was assessed using the Kaplan-Meier method and Cox proportional hazard modeling. RESULTS Among 39,403 patients included for analysis, 29,736 (75.5%) received a lobectomy and 9667 (24.5%) received a sublobar resection: 84.7% wedge resection (n = 8192) and 15.3% segmental resection (n = 1475). Lymph node evaluation was not performed in 2788 (28.8%) of sublobar resection patients, and 7298 (75.5%) of sublobar resections were for tumors ≤ 2 cm. After multivariable logistic regression, older age, higher Charlson-Deyo comorbidity scores, smaller tumor size, and treatment at lower-volume institutions were associated with sublobar resection (all P < .001). Overall, lobectomy was associated with significantly improved 5-year survival compared to sublobar resection (66.2% vs. 51.2%; P < .001, adjusted hazard ratio 0.66; P < .001). However among sublobar resection patients, nodal sampling was associated with significantly better 5-year survival (58.2% vs. 46.4%; P < .001). CONCLUSION Despite adjustment for patient and tumor related characteristics, a sublobar resection is associated with significantly reduced long-term survival compared to a formal surgical lobectomy among patients with NSCLC, even for stage 1A tumors. For patients who cannot tolerate lobectomy and who are treated with sublobar resection, lymph node evaluation is essential to help guide further treatment.
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Affiliation(s)
- Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Lin Gu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Mark F Berry
- Department of Surgery, Duke University Medical Center, Durham, NC; Department of Cardiothoracic Surgery, Stanford University, Stanford, CA.
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Could less be more?-A systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection. Lung Cancer 2015; 89:121-32. [PMID: 26033208 DOI: 10.1016/j.lungcan.2015.05.010] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/06/2015] [Accepted: 05/12/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES There is renewed interest in performing segmentectomies and wedge resections for selected patients with early-stage non-small cell lung cancer. However, comparative data on sublobar resections versus lobectomies include 'intentionally selected' patients who could tolerate either procedure, or 'compromised' patients who could only undergo sublobar resections due to significant comorbidities or insufficient cardiopulmonary reserve. To address this important point, the present meta-analysis aimed to compare the survival outcomes of sublobar resections and segmentectomies versus lobectomies based on patient selection and surgical intent. METHODS A systematic review was performed using 6 online databases to identify all comparative studies that presented survival data on sublobar resections versus lobectomy procedures. These studies were then categorized according to the patient selection process for those who underwent sublobar resections. Patients were considered 'intentionally selected' if they could have tolerated either procedure, 'compromised' if they underwent a sublobar resection due to ineligibility for a lobectomy, or 'non-specified'. RESULTS Fifty-four studies, including a single randomized controlled trial, involving 38,959 patients were found to meet the predefined selection criteria. For sublobar resections, comparative data demonstrated no significant difference in overall survival in the 'intentionally selected' group, but a significantly worse outcome for sublobar resections in the 'compromised group'. Similarly, for the comparison of segmentectomies versus lobectomies, available data demonstrated no significant difference in overall survival in the 'intentionally selected' group, but a significantly worse outcome for segmentectomy in the 'compromised group'. CONCLUSIONS The present meta-analysis was the first to emphasize the patient selection process to compare 'intentionally selected' and 'compromised' patients who underwent sublobar resections versus lobectomies. Our results suggested that segmentectomies may be a feasible alternative for selected patients who could tolerate either procedure. These patients generally had tumours that were <2cm, located peripherally with favourable histopathology, and with ground-glass opacity on imaging.
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82
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Yu JB, Soulos PR, Cramer LD, Decker RH, Kim AW, Gross CP. Comparative effectiveness of surgery and radiosurgery for stage I non-small cell lung cancer. Cancer 2015; 121:2341-9. [PMID: 25847699 DOI: 10.1002/cncr.29359] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although surgery is the standard treatment for early-stage non-small cell lung cancer (NSCLC), stereotactic body radiotherapy (SBRT) has been disseminated as an alternative therapy. The comparative mortalities and toxicities of these treatments for patients of different life expectancies are unknown. METHODS The Surveillance, Epidemiology, and End Results-Medicare linked database was used to identify patients who were 67 years old or older and underwent SBRT or surgery for stage I NSCLC from 2007 to 2009. Matched patients were stratified into short life expectancies (<5 years) and long life expectancies (≥5 years). Mortality and complication rates were compared with Poisson regression. RESULTS Overall, 367 SBRT patients and 711 surgery patients were matched. Acute toxicity (0-1 month) was lower from SBRT versus surgery (7.9% vs 54.9%, P < .001). At 24 months after treatment, there was no difference (69.7% vs 73.9%, P = .31). The incidence rate ratio (IRR) for toxicity from SBRT versus surgery was 0.74 (95% confidence interval [CI], 0.64-0.87). Overall mortality was lower with SBRT versus surgery at 3 months (2.2% vs 6.1%, P = .005), but by 24 months, overall mortality was higher with SBRT (40.1% vs 22.3%, P < .001). For patients with short life expectancies, there was no difference in lung cancer mortality (IRR, 1.01; 95% CI, 0.40-2.56). However, for patients with long life expectancies, there was greater overall mortality (IRR, 1.49; 95% CI, 1.11-2.01) as well as a trend toward greater lung cancer mortality (IRR, 1.63; 95% CI, 0.95-2.79) with SBRT versus surgery. CONCLUSIONS SBRT was associated with lower immediate mortality and toxicity in comparison with surgery. However, for patients with long life expectancies, there appears to be a relative benefit from surgery versus SBRT.
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Affiliation(s)
- James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Laura D Cramer
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.,Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Anthony W Kim
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut.,Department of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut
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Zhang Y, Sun Y, Wang R, Ye T, Zhang Y, Chen H. Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer. J Surg Oncol 2014; 111:334-40. [PMID: 25322915 DOI: 10.1002/jso.23800] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/05/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Survival difference following lobectomy, segmentectomy, and wedge resection in stage I non-small cell lung cancer (NSCLC) and its subgroups remains undetermined. METHODS We systemically searched published articles comparing recurrence-free survival (RFS), overall survival (OS), or cancer-specific survival (CSS) between lobectomy and limited resection or between segmentectomy and wedge resection. RESULTS A total of 42 studies published from 1980 to 2014 enrolling 21,926 patients were included in this meta-analysis. Survival results favored lobectomy in stage IA NSCLC ≤2 cm (combined HR: 1.530, 95% CI: 1.402-1.671, P < 0.001) or patient's ≥65 years old (combined HR: 1.227, 95% CI: 1.003-1.502, P = 0.047). Survival outcome of video-assisted thoracoscopic (VATS) sublobectomy was comparable to that of VATS lobectomy (pooled HR: 0.808, 95% CI: 0.556-1.174, P = 0.263). The combined HR of segmentectomy versus lobectomy was 1.231 (95% CI: 1.070-1.417, P = 0.004), while the pooled HR of wedge resection versus segmentectomy was 1.542 (95% CI: 0.856-2.780, P = 0.149). CONCLUSIONS This study suggested that tumor size or age alone should not be the criteria to encourage sublobar resection. For stage I NSCLC, survival following segmentectomy was inferior to lobectomy. Patients undergoing intentional sublobectomy achieved comparable survival as those who received lobectomy.
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Affiliation(s)
- Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Wang Z, Zhang J, Cheng Z, Li X, Wang Z, Liu C, Xie Z. Factors affecting major morbidity after video-assisted thoracic surgery for lung cancer. J Surg Res 2014; 192:628-34. [PMID: 25167779 DOI: 10.1016/j.jss.2014.07.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/05/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) has been widely applied in the treatment of lung cancer. However, few studies have focused on the clinical factors predicting the major postoperative complications. METHODS Clinical data from 525 patients who underwent resection of primary lung cancer with VATS from January 2007-August 2011 were retrospectively analyzed. Risk factors related to major postoperative complications were assessed by univariate and multivariate analyses with logistic regression. RESULTS Major complications occurred in 36 (6.86%) patients, of which seven died (1.33%) within 30 d, postoperatively. Major complications included respiratory failure, hemothorax, myocardial infarction, heart failure, bronchial fistula, cerebral infarction, and pulmonary embolism. Univariate and multivariate logistic regression analyses demonstrated that age >70 y (odds ratio [OR], 2.105; 95% confidence interval [CI] 1.205-3.865), forced expiratory volume during the first second expressed as a percentage of predicted ≤70% (OR, 2.106; 95% CI 1.147-3.982) combined with coronary heart disease (OR, 2.257; 95% CI 1.209-4.123) were independent prognostic factors for major complications. CONCLUSIONS Age >70 and forced expiratory volume during the first second expressed as a percentage of predicted ≤70% combined with coronary heart disease are independent prognostic factors for postoperative major complications. Patients in these groups should undergo careful preoperative evaluation and perioperative management.
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Affiliation(s)
- Zhiqiang Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Jiru Zhang
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Zhou Cheng
- Department of Emergency Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Xianhua Li
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Zhenjun Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Chuanxin Liu
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Zongtao Xie
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China.
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Villamizar N, Swanson SJ. Lobectomy vs. segmentectomy for NSCLC (T<2 cm). Ann Cardiothorac Surg 2014; 3:160-6. [PMID: 24790839 DOI: 10.3978/j.issn.2225-319x.2014.02.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/22/2014] [Indexed: 11/14/2022]
Abstract
The extent of surgical resection for peripheral clinical T1N0M0 non-small cell lung cancer (NSCLC) ≤2 cm continues to be a matter of debate. Eighteen years ago, a randomized controlled trial (RCT) established lobectomy as the standard of care for peripheral clinical T1N0M0 NSCLC. However, numerous publications since then have reported similar outcomes for patients treated with segmentectomy or lobectomy for peripheral clinical T1N0M0 NSCLC 2 cm or smaller in size. The majority of these publications are retrospective studies. Two ongoing RCTs aim to resolve this debate, one in Japan and the other in the United States. This manuscript is a comprehensive review of the literature that compares lobectomy to segmentectomy for peripheral clinical T1N0M0 NSCLC 2 cm or smaller in size. Until data from the ongoing RCTs become available, this literature review provides the best evidence to guide the thoracic surgeon in the management of these patients.
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Affiliation(s)
- Nestor Villamizar
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott J Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Liu Y, Huang C, Liu H, Chen Y, Li S. Sublobectomy versus lobectomy for stage IA (T1a) non-small-cell lung cancer: a meta-analysis study. World J Surg Oncol 2014; 12:138. [PMID: 24886396 PMCID: PMC4029973 DOI: 10.1186/1477-7819-12-138] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/11/2014] [Indexed: 12/21/2022] Open
Abstract
Background Although lobectomy is considered the standard surgical treatment for the majority of patients with non-small-cell lung cancer (NSCLC), the operation project for patients with stage IA NSCLC (T1a, tumor diameter ≤2 cm) remains controversial. Sublobectomy is appropriate only in certain patients as many doctors consider it to be overtreatment. We evaluated the five-year overall survival rate of sublobectomy and lobectomy for stage IA NSCLC (T1a, tumor diameter ≤2 cm) through a meta-analysis. Methods The five-year overall survival rate (OS) of stage IA (T1a) NSCLC after sublobectomy (including wedge resection and segmentectomy) and lobectomy were compared. We also compared the OS of stage IA (T1a) NSCLC after segmentectomy and lobectomy. The log (hazard ratio, ln (HR)) and its standard error (SE) were used as the outcome measure for data combining. Results There were 12 eligible studies published between 1994 and 2013 in which the total number of participants was 18,720. When compared to lobectomy, there was a statistically significant difference of sublobectomy on OS of stage IA (T1a) NSCLC patients (HR 1.38; 95% confidence interval (95% CI), 1.19 to 1.61; P <0.0001). For the comparison between segmentectomy and lobectomy, there was also a statistically significant difference of segmentectomy alone on OS of stage IA (T1a) NSCLC patients (HR 1.48; 95% CI: 1.27 to 1.73; P <0.00001) Conclusions We have concluded that in stage IA (T1a) patients sublobectomy, including segmentectomy and wedge resection, causes a lower survival rate than lobectomy.
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Affiliation(s)
| | | | | | | | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Shuaifuyuan No,1 Dongcheng District, Beijing 100730, China.
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Girard N, Gounant V, Mennecier B, Greillier L, Cortot A, Couraud S, Besse B, Brouchet L, Castelnau O, Ferretti G, Frappé P, Khalil A, Lefebure P, Laurent F, Liebart S, Margery J, Molinier O, Quoix E, Revel MP, Stach B, Souquet PJ, Thomas P, Trédaniel J, Lemarié E, Zalcman G, Barlési F, Milleron B. Le dépistage individuel du cancer broncho-pulmonaire en pratique. Perspectives sur les propositions du groupe de travail pluridisciplinaire de l’Intergroupe francophone de cancérologie thoracique, de la Société d’imagerie thoracique et du Groupe d’oncologie de langue française. Rev Mal Respir 2014; 31:91-103. [DOI: 10.1016/j.rmr.2013.10.641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/18/2013] [Indexed: 12/21/2022]
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88
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Bao F, Ye P, Yang Y, Wang L, Zhang C, Lv X, Hu J. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg 2013; 46:1-7. [PMID: 24321996 DOI: 10.1093/ejcts/ezt554] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Early stage lung cancer is routinely treated by lobectomy whenever clinically feasible, whereas the role of segmentectomy is controversial. The purpose of this study was to investigate the benefits of segmentectomy vs lobectomy for early stage lung cancer through a meta-analysis of published data. Eligible studies were identified from MEDLINE through February 2013. The manual selection of relevant studies was based on the summary analysis. We used published hazard ratios (HRs) if available or estimates from the published survival data. Lobectomy was chosen as the reference in all HR calculations. We compared the effect of segmentectomy and lobectomy for Stage I, Stage IA, Stage IA with tumours larger than 2 cm but smaller than 3 cm in size and Stage IA with tumours of 2 cm or smaller in 22 observational studies. The HRs of overall and cancer-specific survival indicated significant benefits of lobectomy for Stage I, Stage IA and Stage IA with tumours larger than 2 cm but smaller than 3 cm at 1.20 (95% confidence interval [CI] 1.04-1.38; P = 0.011), 1.24 (95% CI 1.08-1.42; P = 0.002) and 1.41 (95% CI 1.14-1.71; P = 0.001), respectively. For tumours 2 cm or smaller, segmentectomy provided an effect equivalent to that of lobectomy (HR 1.05; 95% CI 0.89-1.24; P = 0.550). No significant publication bias was detected in any part of the analysis. These findings should be interpreted in the context of the inherent limitations of meta-analyses of retrospective studies, including the heterogeneity of patient characteristics.
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Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Peng Ye
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yunhai Yang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Luming Wang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chong Zhang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiayi Lv
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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89
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Zhang Z, Mao Y. [Diagnosis and management of solitary pulmonary nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2013; 16:499-508. [PMID: 24034999 PMCID: PMC6000634 DOI: 10.3779/j.issn.1009-3419.2013.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
目前,肺癌已跃居成为我国发病率及死亡率最高的恶性肿瘤,总体5年生存率较低;早诊早治是提高肺癌患者生存率及改善预后的关键,而早期肺癌患者常无任何症状和体征,只在影像学上表现为肺孤立性结节病变。提高对孤立性肺结节良恶性的鉴别诊断能力是临床诊治过程中的难点与热点。随着各种诊治技术的发展,孤立性肺结节病变性质的诊断准确率已大大提高。
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Affiliation(s)
- Zhirong Zhang
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Mediacal College & Chinese Academy of Medical Sciences, Beijing 100021, China
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