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Aguinagalde B, Ferrer-Bonsoms JA, López I, Lizarbe IA, Fernández-Monge A, Recuero JL, Royo I, Embún R. Comparison of 5-Year Survival and Disease Recurrence After Trisegmentectomy or Left Upper Lobectomy: A Propensity Score Analysis of the National GEVATS Database. Arch Bronconeumol 2024:S0300-2896(24)00214-X. [PMID: 38971669 DOI: 10.1016/j.arbres.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Trisegmentectomy, or resection of the upper subdivision of the left upper lobe with preservation of the lingula, is considered by some authors to be equivalent to right upper lobectomy with middle lobe preservation. Our objective was to compare survival and recurrence after trisegmentectomy versus left upper lobectomy procedures registered in the Spanish Video-Assisted Thoracic Surgery group (GEVATS) database. METHODS We compared mortality, survival and recurrence in patients with left upper lobectomy or trisegmentectomy after propensity score matching for the following variables: age, smoking habit, tumor size, histologic type, radiological density of tumor, surgical access, forced expiratory volume in one second, diffusing capacity of the lungs for carbon monoxide, hypertension, chronic heart failure, ischemic heart disease, arrhythmia, stroke, peripheral vascular disease, diabetes and pre-surgery nodal status by positron emission tomography/computed tomography. RESULTS A total of 540 left upper lobectomies and 83 trisegmentectomies were registered in the GEVATS database. After propensity score matching, 134 left upper lobectomies and 67 trisegmentectomies were selected. Survival outcomes were similar, but differences were found for recurrence (21.5% for trisegmentectomies vs. 35.4% for left upper lobectomies, p=0.05). Moreover, the recurrence patterns differed, with the lobectomy group showing a greater tendency to distant dissemination. CONCLUSIONS Trisegmentectomy and left upper lobectomy show similar 5-year survival rates. In our database, recurrence after trisegmentectomy was lower than after left upper lobectomy, while the recurrence pattern differed among the 2 surgical approaches, with a greater tendency to distant metastasis after left upper lobectomy.
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Affiliation(s)
- Borja Aguinagalde
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Department of Surgery, UPV/EHU, Leioa, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain.
| | - Juan A Ferrer-Bonsoms
- Biomedical Engineering and Science Department, TECNUN, Universidad de Navarra, San Sebastian, Spain
| | - Iker López
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - Ion Ander Lizarbe
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - Arantza Fernández-Monge
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - José Luis Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Iñigo Royo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Raúl Embún
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Universidad Zaragoza, Zaragoza, Spain
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Tane S, Okami J, Maniwa Y, Shintani Y, Ito H, Ohtsuka T, Toyooka S, Mori T, Watanabe SI, Chida M, Endo S, Nakanishi R, Kadokura M, Suzuki H, Miyaoka E, Yoshino I, Date H. Clinical outcomes of left upper segmentectomy vs. lobectomy for early non-small-cell lung cancer: a nationwide database study in Japan. Surg Today 2024:10.1007/s00595-024-02844-8. [PMID: 38635057 DOI: 10.1007/s00595-024-02844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/09/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Given that left upper lobe and right upper and middle lobes share a similar anatomy, segmentectomy, such as upper division and lingulectomy, should yield identical oncological clearance to left upper lobectomy. We compared the prognosis of segmentectomy with that of lobectomy for early stage non-small-cell lung cancer (NSCLC) in the left upper lobe. METHODS We retrospectively examined 2115 patients who underwent segmentectomy or lobectomy for c-stage I (TNM 8th edition) NSCLC in the left upper lobe in 2010. We compared the oncological outcomes of segmentectomy (n = 483) and lobectomy (n = 483) using a propensity score matching analysis. RESULTS The 5-year recurrence-free and overall survival rates in the segmentectomy and lobectomy groups were comparable, irrespective of c-stage IA or IB. Subset analyses according to radiological tumor findings showed that segmentectomy yielded oncological outcomes comparable to those of lobectomy for non-pure solid tumors. In cases where the solid tumor exceeded 20 mm, segmentectomy showed a recurrence-free survival inferior to that of lobectomy (p = 0.028), despite an equivalent overall survival (p = 0.38). CONCLUSION Segmentectomy may be an acceptable alternative to lobectomy with regard to the overall survival of patients with c-stage I NSCLC in the left upper lobe.
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Affiliation(s)
- Shinya Tane
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Ohtsuka
- Division of General Thoracic Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takeshi Mori
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Japan
| | - Shunsuke Endo
- Department of Thoracic Surgery, Jichi Ika University Saitama Medical Center, Saitama, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsutaka Kadokura
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Tokyo University of Science, Tokyo, Japan
| | - Ichiro Yoshino
- Department of Thoracic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Wu LL, Jiang WM, Qian JY, Tian JY, Li ZX, Li K, Ma GW, Xie D, Chen C. High-risk characteristics of pathological stage I lung adenocarcinoma after resection: patients for whom adjuvant chemotherapy should be performed. Heliyon 2023; 9:e23207. [PMID: 38144332 PMCID: PMC10746451 DOI: 10.1016/j.heliyon.2023.e23207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023] Open
Abstract
Background The objective of the present study was to identify patients with pathologic stage I lung adenocarcinoma (LUAD) who are at high risk of recurrence and assess the efficacy of adjuvant chemotherapy (ACT) in these individuals. Methods A retrospective study was conducted on 1504 patients with pathologic stage I LUAD who underwent surgical resection at Shanghai Pulmonary Hospital and Sun Yat-sen University Cancer Center. Cox proportional hazard regression analyses were performed to identify indicators associated with a high risk of recurrence, while the Kaplan-Meier method and Log-rank test were employed to compare recurrence-free survival (RFS) and overall survival (OS) between patients with ACT and those without it. Results Four independent indicators, including age (≥62 years), visceral pleural invasion (VPI), predominant pattern (micropapillary/solid), and lymphovascular invasion (LVI), were identified to be significantly related with RFS. Subsequently, patients were classified into high-risk and low-risk groups by LVI, VPI, and predominant pattern. The administration of ACT significantly increased both RFS (P < 0.001) and OS (P = 0.03) in the high-risk group (n = 250). Conversely, no significant difference was observed in either RFS (P = 0.45) or OS (P = 0.063) between ACT and non-ACT patients in the low-risk group (n = 1254). Conclusions Postoperative patients with stage I LUAD with factors such as LVI, VPI, and micropapillary/solid predominant pattern may benefit from ACT.
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Affiliation(s)
- Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, PR China
| | - Wen-Mei Jiang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510000, PR China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, PR China
| | - Jia-Yuan Tian
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510000, PR China
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, PR China
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, PR China
| | - Guo-Wei Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510000, PR China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, PR China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, PR China
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Tane S, Nishioka Y, Tanaka Y, Uchino K, Nishio W, Maniwa Y. Uniportal left S1 + 2 segmentectomy. Gen Thorac Cardiovasc Surg 2023:10.1007/s11748-023-01929-4. [PMID: 36947292 DOI: 10.1007/s11748-023-01929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
The left upper lobe is one of the largest lobes of the lung; left upper segmentectomy is well established among thoracic surgeons. In uniportal left S1 + 2 segmentectomy, dissection of the vasculature, bronchus, and intersegmental plane can be performed anteriorly. Given that the fissureless technique is commonly used in uniportal video-assisted thoracoscopic surgery, S1 + 2 segmentectomy exhibits high affinity with the unidirectional approach. We have frequently performed left S1 + 2 segmentectomy for early non-small cell lung cancer located in the apical segment, since this procedure has the potential to preserve pulmonary function over tri-segmentectomy. Herein, we introduce our approach to uniportal left S1 + 2 segmentectomy as a minimally invasive alternative for preserving lung function.
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Affiliation(s)
- Shinya Tane
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo Ward, Kobe, 650-0017, Japan.
| | - Yuki Nishioka
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo Ward, Kobe, 650-0017, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo Ward, Kobe, 650-0017, Japan
| | - Kazuya Uchino
- Department of General Thoracic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Wataru Nishio
- Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo Ward, Kobe, 650-0017, Japan
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Bayfield NGR, Bibo L, Wang E, Edelman J. Left Upper Lobe Multi-Segmentectomy Vs Lobectomy for Early-Stage Lung Cancer: A Meta-Analysis. Heart Lung Circ 2023; 32:596-603. [PMID: 36959019 DOI: 10.1016/j.hlc.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION The left upper lobe (LUL) has unique hilar anatomy, and LUL multi-segmentectomy (apical trisegmentectomy and lingulectomy) may result in different outcomes than both single anatomical segmentectomy and left upper lobectomy in the management of early-stage primary lung cancer; however no meta-analyses have been performed. The aim of this meta-analysis is to determine if LUL multi-segmentectomy is non-inferior to left upper lobectomy for long-term survival outcomes, or superior for in-hospital outcomes. METHODS Electronic databases searches were performed on PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes in LUL multi-segmentectomy vs left upper lobectomy in early-stage lung cancer (clinical stage T2 N0 or less). Long-term postoperative overall and disease-free survival were assessed via reconstruction of Kaplan-Meier survival curves. In-hospital complications and length of stay, as well as long term recurrence were analysed via random effects models. RESULTS Five relevant studies were identified, including 1,196 patients. Overall survival did not differ at 5 years (multi-segmentectomy 92.6% vs lobectomy 89.3%, P=0.188), but patients undergoing LUL multi-segmentectomy had better disease-free survival at 5 years (93.1% vs 88.4%, P=0.041). Patients undergoing LUL multi-segmentectomy had a shorter mean length of hospital stay (mean difference -0.26 days, 95% CI; -0.39 to 0.14, P<0.01, I2=0.00%). There was no difference in combined in-hospital complications (P=0.14), local recurrence (P=0.35), distant recurrence (P=0.23), or overall recurrence (P=0.39). CONCLUSION LUL multi-segmentectomy is associated with reduced hospital length of stay, but no difference in long-term overall survival compared with left upper lobectomy in the management of early-stage primary lung cancer.
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Affiliation(s)
- Nicholas G R Bayfield
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia.
| | - Liam Bibo
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - Edward Wang
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
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A Novel Systematic Oxidative Stress Score Predicts the Survival of Patients with Early-Stage Lung Adenocarcinoma. Cancers (Basel) 2023; 15:cancers15061718. [PMID: 36980604 PMCID: PMC10099732 DOI: 10.3390/cancers15061718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
This study aimed to construct an effective nomogram based on the clinical and oxidative stress-related characteristics to predict the prognosis of stage I lung adenocarcinoma (LUAD). A retrospective study was performed on 955 eligible patients with stage I LUAD after surgery at our hospital. The relationship between systematic-oxidative-stress biomarkers and the prognosis was analyzed. The systematic oxidative stress score (SOS) was established based on three biochemical indicators, including serum creatinine (CRE), lactate dehydrogenase (LDH), and uric acid (UA). SOS was an independent prognostic factor for stage I LUADs, and the nomogram based on SOS and clinical characteristics could accurately predict the prognosis of these patients. The nomogram had a high concordance index (C-index) (0.684, 95% CI, 0.656–0.712), and the calibration curves for recurrence-free survival (RFS) probabilities showed a strong agreement between the nomogram prediction and actual observation. Additionally, the patients were divided into two groups according to the cut-off value of risk points based on the nomogram, and a significant difference in RFS was observed between the high-risk and low-risk groups (p < 0.0001). SOS is an independent prognostic indicator for stage I LUAD. These things considered, the constructed nomogram based on SOS could accurately predict the survival of those patients.
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Nishikubo M, Tane S, Kimura K, Shimizu N, Kitamura Y, Nishio W. Comparison of oncological outcomes between trisegmentectomy and lobectomy for non-small cell lung cancer in the left upper division. J Thorac Dis 2022; 14:4614-4623. [PMID: 36647461 PMCID: PMC9840034 DOI: 10.21037/jtd-22-950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The left upper lobe is one of the largest lobes in the lungs and is divided into two anatomical units: the upper division (segments 1+2 and segment 3) and lingula (segments 4 and 5). This anatomical classification is similar to that used for the right upper and middle lobes. Although bilobectomy is not recommended for right upper or middle lobe tumors close to the interlobar plane, lobectomy is often performed for tumors located close to the intersegmental plane in the left upper division. To aid in establishing trisegmentectomy as a standard treatment for clinical N0 non-small cell lung cancer (NSCLC) in the left upper lobe, we aimed to re-assess its feasibility based on oncological outcomes according to tumor location. METHODS We retrospectively analyzed the data of patients with clinical N0 NSCLC in the left upper division who underwent left upper lobectomy or trisegmentectomy between April 2006 and December 2020. After propensity score matching, oncological outcomes were compared between the trisegmentectomy and lobectomy groups. To verify whether trisegmentectomy was indicated regardless of tumor distance from the intersegmental plane, we compared the recurrence-free survival (RFS) rates following trisegmentectomy between patients with tumors ≤20 and >20 mm from the intersegmental plane. RESULTS After propensity score matching, 46 patients were included in each group. There was no significant difference in the 5-year RFS rate between the lobectomy and trisegmentectomy groups (75.5% vs. 84.0%, P=0.41). In the trisegmentectomy cohort, the 5-year RFS rate did not significantly differ according to tumor distance from the intersegmental plane (≤20 or >20 mm) measured using three-dimensional computed tomography (79.4% vs. 81.2%, P=0.69). Multivariate analysis indicated that tumor distance from the intersegmental plane was not a significant predictor of RFS (hazard ratio: 1.75, 95% confidence interval: 0.52-5.91, P=0.37). CONCLUSIONS Our analysis suggests that oncological outcomes (i.e., RFS rates) following trisegmentectomy for clinical N0 NSCLC in the left upper division are not significantly inferior to those following lobectomy, even if the tumor is located close to the intersegmental plane.
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Affiliation(s)
| | | | - Kenji Kimura
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Nahoko Shimizu
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | | | - Wataru Nishio
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
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Ohtaki Y, Yajima T, Nagashima T, Nakazawa S, Kawatani N, Obayashi K, Yazawa T, Shimizu K, Shirabe K. Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division. Gan To Kagaku Ryoho 2022; 70:962-970. [DOI: 10.1007/s11748-022-01816-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
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