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Ventura L, Fiorelli A, Rossi M, Gnetti L, Natale G, Wang Y, Carbognani P, Fang W, Waller D. Is Lobectomy Actually Worse Than Segmentectomy for All Stage I Non-Small Cell Lung Cancer? J Surg Res 2024; 300:298-308. [PMID: 38838427 DOI: 10.1016/j.jss.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 03/24/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The recent results of the JCOG 0802 and CALGB 140503 studies suggest that segmentectomy should be considered instead of lobectomy for patients with peripheral <2 cm node-negative non-small cell lung cancer (NSCLC). This study aimed to test this hypothesis in a retrospective analysis of a larger dataset of patients with stage I NSCLC recorded in the Surveillance, Epidemiology, and End Results database. METHODS Patients with all stage I NSCLC (≤4 cm in size) who underwent either segmentectomy or lobectomy from 2000 to 2017 were analyzed. The primary endpoints were overall survival and lung cancer-specific survival, while the secondary endpoints were the 30-day and 90-day mortality. RESULTS Overall, 32,673 patients treated by lobectomy and 2166 patients treated by segmentectomy were included in the initial data collection. After 1:1 propensity score matching (PSM), 2016 patients in each group were enrolled in the final analysis with well-balanced baseline characteristics. After PSM, there was no difference between segmentectomy and lobectomy for all stage IA NSCLC (≤3 cm in size) in both overall survival and lung cancer-specific survival (hazard ratio: 0.87 [0.74-1.02], P value: 0.09 and hazard ratio: 0.81 [0.4-1.03], P value: 0.09, respectively). Furthermore, lobectomy had higher 30-day mortality than segmentectomy: 1.1% versus 2.1%, P value: 0.01. However, this difference was not significant for 90-day mortality, even after PSM (3.9% versus 3.0%, P value: 0.17). CONCLUSIONS We found no evidence to support the use of lobectomy rather than segmentectomy in stage IA NSCLC in terms of either overall or lung cancer-specific long-term survival. The choice of lobectomy may also be detrimental to early postoperative recovery.
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Affiliation(s)
- Luigi Ventura
- Cardiothoracic Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Rossi
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Paolo Carbognani
- Thoracic Surgery Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - David Waller
- Barts Thorax Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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2
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Mamede I, Ribeiro L, Stecca C, Escalante-Romero L, Cypel M. Survival and pulmonary function in stage IA non-small cell lung cancer after sublobar resection versus lobectomy: An updated meta-analysis. J Surg Oncol 2024. [PMID: 38979906 DOI: 10.1002/jso.27767] [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: 04/15/2024] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
Traditionally, lobectomy was standard for stage IA non-small-cell lung cancer (NSCLC). Recent RCTs suggest sublobar resection's comparable outcomes. Our meta-analysis, incorporating 30 studies (including four RCTs), assessed sublobar resection's efficacy. Employing a random-effects model and I2 statistics for heterogeneity, we found sublobar resection reduced DFS (HR 1.31, p < 0.01) and OS (HR 1.27, p < 0.01) overall. However, RCT subgroup analysis showed no significant differences in DFS (p = 0.28) or OS (p = 0.62). Sublobar resection is a viable option for well-selected patients.
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Affiliation(s)
- Isadora Mamede
- Department of Medicine, Federal University of Sao Joao del-Rei, Divinopolis, Brazil
| | - Leonardo Ribeiro
- Department of Medicine, Pontifical Catholic University of Sao Paulo, São Paulo, Brazil
| | - Carlos Stecca
- Department of Medical Oncology, Mackenzie Evangelical University Hospital, Curitiba, Brazil
| | | | - Marcelo Cypel
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Li T, He W, Zhang X, Zhou Y, Wang D, Huang S, Li X, Fu Y. Survival outcomes of segmentectomy and lobectomy for early stage non-small cell lung cancer: a systematic review and meta-analysis. J Cardiothorac Surg 2024; 19:353. [PMID: 38909240 PMCID: PMC11193294 DOI: 10.1186/s13019-024-02832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/14/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND The question of whether segmentectomy and lobectomy have similar survival outcomes for patients with early-stage non-small cell lung cancer (NSCLC) is a matter of debate. METHODS A cohort study and randomized controlled trial were included, comparing segmentectomy and lobectomy, by utilizing computerized access to the Pubmed, Web of Science, and Cochrane Library databases up until July 2022. The Cochrane Collaboration tool was used to evaluate the randomized controlled trials, while the Newcastle-Ottawa Scale (NOS) was used to evaluate the cohort studies. Sensitivity analyses were also carried out. RESULTS The analysis incorporated 17 literature studies, including one randomized controlled trial and 16 cohort studies, and was divided into a segmentectomy group (n = 2081) and a lobectomy group (n = 2395) based on the type of surgery the patient underwent. Each study was followed up from 27 months to 130.8 months after surgery. Over survival (OS): HR = 1.14, 95%CI(0.97,1.32), P = 0.10; disease-free survival (DFS): HR = 1.13, 95%CI(0.91,1.41), P = 0.27; recurrence-free survival (RFS): HR = 0.95, 95%CI(0.81,1.12), P = 0.54. CONCLUSION The results of the study suggest that the survival outcomes of the segmentectomy group were not inferior to that of the lobectomy group. Segmentectomy should therefore be considered as a treatment option for early stage NSCLC.
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Affiliation(s)
- Tongxin Li
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China
| | - Wang He
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China
| | - Xiaolong Zhang
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China
| | - Yu Zhou
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China
| | - Dong Wang
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China
| | - Shengyuan Huang
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China
| | - Xiangyang Li
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China
| | - Yong Fu
- Department of Cardiothoracic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing. No.116 Beijie, Guixi Street, Dianjiang County, Chongqing, 408300, China.
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Henschke C, Huber R, Jiang L, Yang D, Cavic M, Schmidt H, Kazerooni E, Zulueta JJ, Sales Dos Santos R, Ventura L. Perspective on Management of Low-Dose Computed Tomography Findings on Low-Dose Computed Tomography Examinations for Lung Cancer Screening. From the International Association for the Study of Lung Cancer Early Detection and Screening Committee. J Thorac Oncol 2024; 19:565-580. [PMID: 37979778 DOI: 10.1016/j.jtho.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Lung cancer screening using low-dose computed tomography (LDCT) carefully implemented has been found to reduce deaths from lung cancer. Optimal management starts with selection of eligibility criteria, counseling of screenees, smoking cessation, selection of the regimen of screening which specifies the imaging protocol, and workup of LDCT findings. Coordination of clinical, radiologic, and interventional teams and ultimately treatment of diagnosed lung cancers under screening determine the benefit of LDCT screening. Ethical considerations of who should be eligible for LDCT screening programs are important to provide the benefit to as many people at risk of lung cancer as possible. Unanticipated diseases identified on LDCT may offer important benefits through early detection of leading global causes of death, such as cardiovascular diseases and chronic obstructive pulmonary disease, as the latter may result from conditions such as emphysema and bronchiectasis, which can be identified early on LDCT. This report identifies the key components of the regimen of LDCT screening for lung cancer which include the need for a management system to provide data for continuous updating of the regimen and provides quality assurance assessment of actual screenings. Multidisciplinary clinical management is needed to maximize the benefit of early detection, diagnosis, and treatment of lung cancer. Different regimens have been evolving throughout the world as the resources and needs may be different, for countries with limited resources. Sharing of results, further knowledge, and incorporation of technologic advances will continue to accelerate worldwide improvements in the diagnostic and treatment approaches.
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Affiliation(s)
- Claudia Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rudolf Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine, University of Munich - Campus Innenstadt, Ziemssenstrabe, Munich, Germany
| | - Long Jiang
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dawei Yang
- Department of Pulmonary Medicine and Critical Care, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Milena Cavic
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Heidi Schmidt
- Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - Ella Kazerooni
- Division of Cardiothoracic Radiology and Internal Medicine, University of Michigan Medical School, Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Javier J Zulueta
- Department of Medicine, Mount Sinai Morningside, New York, New York
| | - Ricardo Sales Dos Santos
- Department of Minimally Invasive Thoracic and Robotic Surgery, Albert Einstein Israeli Hospital, Sao Paulo, Brazil
| | - Luigi Ventura
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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Fiorelli A, Leonardi B, Messina G, Luzzi L, Paladini P, Catelli C, Minervini F, Kestenholz P, Teodonio L, D’Andrilli A, Rendina EA, Natale G. Lung Resection for Non-Small Cell Lung Cancer following Bronchoscopic Lung Volume Reduction for Heterogenous Emphysema. Cancers (Basel) 2024; 16:605. [PMID: 38339355 PMCID: PMC10854739 DOI: 10.3390/cancers16030605] [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: 01/06/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for emphysema. Lung cancer may be associated with emphysema due to common risk factors. Thus, a growing number of patients undergoing BLVR may develop lung cancer. Herein, we evaluated the effects of lung resection for non-small cell lung cancer in patients undergoing BLVR. The clinical data of patients undergoing BLVR followed by lung resection for NSCLC were retrospectively reviewed. For each patient, surgical and oncological outcomes were recorded to define the effects of this strategy. Eight patients were included in our series. In all cases but one, emphysema was localized within upper lobes; the tumor was detected during routine follow-up following BLVR and it did not involve the treated lobe. The comparison of pre- and post-BLVR data showed a significant improvement in FEV1 (29.7 ± 4.9 vs. 33.7 ± 6.7, p = 0.01); in FVC (28.5 ± 6.6 vs. 32.4 ± 6.1, p = 0.01); in DLCO (31.5 ± 4.9 vs. 38.7 ± 5.7, p = 0.02); in 6MWT (237 ± 14 m vs. 271 ± 15 m, p = 0.01); and a reduction in RV (198 ± 11 vs. 143 ± 9.8, p = 0.01). Surgical resection of lung cancer included wedge resection (n = 6); lobectomy (n = 1); and segmentectomy (n = 1). No major complications were observed and the comparison of pre- and post-operative data showed no significant reduction in FEV1% (33.7 ± 6.7 vs. 31.5 ± 5.3; p = 0.15) and in DLCO (38.7 ± 5.7 vs. 36.1 ± 5.4; p = 0.15). Median survival was 35 months and no cancer relapses were observed. The improved lung function obtained with BLVR allowed nonsurgical candidates to undergo lung resection for lung cancer.
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Affiliation(s)
- Alfonso Fiorelli
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Beatrice Leonardi
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Gaetana Messina
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Luca Luzzi
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Piero Paladini
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Chiara Catelli
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Fabrizio Minervini
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Peter Kestenholz
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Leonardo Teodonio
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Antonio D’Andrilli
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Giovanni Natale
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
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6
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Aigner C, Batirel H, Huber RM, Jones DR, Sihoe ADL, Štupnik T, Brunelli A. Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective. Eur Respir Rev 2024; 33:230195. [PMID: 38508666 PMCID: PMC10951859 DOI: 10.1183/16000617.0195-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
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Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University, Istanbul, Turkey
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, and Thoracic Oncology Centre Munich, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan D L Sihoe
- Department of Cardio-Thoracic Surgery, CUHK Medical Centre, Hong Kong, China
| | - Tomaž Štupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
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7
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Potter AL, Kim J, McCarthy ML, Senthil P, Mathey-Andrews C, Kumar A, Cao C, Lin MW, Lanuti M, Martin LW, Jeffrey Yang CF. Segmentectomy versus lobectomy in the United States: Outcomes after resection for first primary lung cancer and treatment patterns for second primary lung cancers. J Thorac Cardiovasc Surg 2024; 167:350-364.e17. [PMID: 37473997 DOI: 10.1016/j.jtcvs.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/08/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The study objective was to identify whether the results of JCOG0802 could be generalized to US clinical settings. METHODS Patients diagnosed with clinical stage IA (≤2 cm) non-small cell lung cancer who underwent segmentectomy versus lobectomy (2004-2017) in the National Cancer Database were identified. Overall survival of patients in the National Cancer Database was assessed using propensity score-matched analysis. A separate analysis of the Surveillance Epidemiology End Results database was conducted to evaluate treatment patterns of second primary lung cancers among patients who underwent segmentectomy versus lobectomy for a first primary lung cancer. RESULTS Of the 23,286 patients in the National Cancer Database meeting inclusion criteria, 1397 (6.0%) underwent segmentectomy and 21,889 (94.0%) underwent lobectomy. In a propensity score-matched analysis of all patients in the study cohort, there were no significant differences in overall survival between patients undergoing segmentectomy versus lobectomy (5-year overall survival: 79.9% [95% CI, 76.7%-82.0%] vs 81.8% [95% CI, 78.7%-84.4%], log-rank: P = .72). In subgroup analyses by tumor grade and histologic subtype, segmentectomy was associated with similar overall survival compared with lobectomy in all subgroups evaluated. In a propensity score-matched analysis of patients in the Surveillance Epidemiology End Results database, there were no significant differences in treatment patterns of second primary lung cancers between patients who underwent segmentectomy and patients who underwent lobectomy for their first primary lung cancer. CONCLUSIONS In this national analysis of US patients diagnosed with stage IA (≤2 cm) non-small cell lung cancer, there were no significant differences in overall survival between segmentectomy and lobectomy in the overall cohort or in subgroup analyses by tumor grade or histologic subtype.
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Affiliation(s)
- Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Joshua Kim
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Meghan L McCarthy
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Priyanka Senthil
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Camille Mathey-Andrews
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Arvind Kumar
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Linda W Martin
- Department of Surgery, University of Virginia, Charlottesville, Va
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
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8
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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9
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Moret A, Madelaine L, Hanna HA, Bernard A, Pagès PB. [Complications after pulmonary segmentectomy: Impact of the surgical approach]. Rev Mal Respir 2023; 40:666-674. [PMID: 37798174 DOI: 10.1016/j.rmr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/14/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Pulmonary segmentectomy is becoming increasingly widespread but remains technically challenging. The aim of this study was to evaluate the impact of the surgical approach applied on postoperative complications after pulmonary segmentectomy. METHODS All patients having undergone pulmonary segmentectomy by thoracotomy, videothoracoscopy or robot-assisted surgery from 1st January 2018 to 31st December 2021 were included. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were operative time, length of hospital stay, 30-day readmission rate, 30-day and 90-day mortality. RESULTS Two hundred and twenty-three patients were included, 30% (n=67) in the thoracotomy group, 9.4% (n=21) in the videothoracoscopy group and 60.5% (n=135) in the robot-assisted surgery group. There was no difference in the occurrence of postoperative complications according to type of approach (P=0.564), 26.9% of patients (n=60) had at least one postoperative complication. There was no significant difference between the groups in terms of operative time (P=0.385), length of hospital stay (P=0.107), 30 and 90-day mortality (P=0.124 and P=0.249, respectively). Mini-invasive surgery significantly reduced the 30-day readmission rate (P=0.049). CONCLUSION The surgical approach applied does not influence the postoperative complications of pulmonary segmentectomy.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Service de chirurgie thoracique, centre hospitalier Métropole Savoie, Chambéry, France
| | - L Madelaine
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - H Abou Hanna
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - A Bernard
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - P-B Pagès
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Inserm, UMR 1231, CHU de Dijon, université de Bourgogne, Dijon, France.
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10
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Zaraca F, Kirschbaum A, Pipitone MD, Bertolaccini L. Prospective randomized study on the efficacy of three-dimensional reconstructions of bronchovascular structures on preoperative chest CT scan in patients who are candidates for pulmonary segmentectomy surgery: the PATCHES (Prospective rAndomized sTudy efficaCy of tHree-dimensional rEconstructions Segmentecomy) study protocol. Trials 2023; 24:594. [PMID: 37717001 PMCID: PMC10504737 DOI: 10.1186/s13063-023-07600-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/22/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION Pulmonary segmentectomy, when combined with hilar and mediastinal lymphadenectomy, is currently considered the gold standard treatment for early-stage lung tumors (NSCLC) smaller than 2 cm in diameter. The preoperative planning for segmentectomies usually includes a contrast-enhanced CT with 2D reconstructions (axial, coronary, and sagittal). Recent technological advances allow 3D (volume rendering) reconstructions of preoperative CT scans, intended to improve the surgeon's understanding of the segmental anatomy. The study aims to investigate the added value of 3D reconstruction in enhancing the surgeon's understanding of anatomical structures, thus facilitating surgical planning and improving oncological outcomes. METHODS AND ANALYSIS This is a prospective, randomized, controlled study. Patients will be randomized into two groups: 1. Group 2D: the preoperative workup for these patients will consist of a contrast-enhanced chest CT with two-dimensional (2D) reconstructions (axial, coronary, and sagittal); 2. Group 3D: the preoperative workup for these patients will consist of a contrast-enhanced chest CT with two-dimensional (2D) reconstructions (axial, coronary, and sagittal) and a 3D reconstruction (volume rendering) of the same chest CT employing dedicated software. The primary endpoints will be negative margin (R0) resection rate, resection margin (staple line-to-tumor distance), and thoracotomy conversions. We will use Fisher's exact test for binary outcomes and Mann-Whitney U test for continuous outcomes. For subgroup analyses, we will use regression. Multivariable analyses will be based on logistic regression for binary outcomes and linear regression for continuous outcomes. ETHICS AND DISSEMINATION The protocol and the model informed consent forms have been reviewed and approved by the ethics committee (N.: 1-2023) concerning scientific content and compliance with applicable research and human subject regulations. A Subcommittee on Publications was established to review all publications and report its recommendations to the steering committee. The anonymized participant-level dataset and statistical code for generating the results will not be publicly available. TRIAL REGISTRATION The protocol was registered at ClinicalTrials.gov (ID: NCT05716815; Prospective rAndomized sTudy efficaCy tHree-dimensional rEconstructions Segmentectomy - Full-Text View - ClinicalTrials.gov). Jan 19, 2023.
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Affiliation(s)
- Francesco Zaraca
- Department of Vascular and Thoracic Surgery, Regional Hospital, Bolzano, Italy
| | - Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, University of Marburg, Marburg, Germany
| | | | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
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11
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Abstract
Sublobar resections are commonly performed operations that have seen an increase in applicability. The sublobar approach, comprising segmentectomy and wedge resections, can provide lung preservation and thus is better tolerated in select patients in comparison to lobectomy. These operations are offered for a variety of benign and malignant lesions. Understanding the indications and technical aspects of these approaches is paramount as improvements in lung cancer screening protocols and the imaging modalities has led to an increase in the detection of early-stage cancer. In this article, we discuss the anatomy, indications, technical approaches, and outcomes for sublobar resection.
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Affiliation(s)
- Benjamin Wei
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA; Birmingham Veterans Administration Medical Center, Birmingham, AL 35233, USA.
| | - Frank Gleason
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Vervoorn MT, Wulfse M, Mohamed Hoesein FAA, Stellingwerf M, van der Kaaij NP, de Heer LM. Application of three-dimensional computed tomography imaging and reconstructive techniques in lung surgery: A mini-review. Front Surg 2022; 9:1079857. [PMID: 36632523 PMCID: PMC9826793 DOI: 10.3389/fsurg.2022.1079857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022] Open
Abstract
Background Pulmonary surgery is an innovative discipline with increasing demands for minimally invasive techniques in complicated anatomical resections, warranting adequate preoperative imaging of relevant surgical anatomy to ensure safe and radical resection of target lesions. Over the recent years, the emergence of imaging techniques enabling three-dimensional reconstruction has exerted promising influence on pulmonary surgery, facilitating optimal surgical planning and easier identification of the spatial relationship between bronchovascular structures in the individual patient and aiding the safe resection of target pulmonary lesions. The goal of this mini-review is to provide an overview of three-dimensional computed tomography imaging within pulmonary surgery. Methods The authors performed a targeted qualitative review of the literature to identify current trends and to provide better understanding of three-dimensional reconstruction within the boundaries of pulmonary surgery. Results Three-dimensional reconstructive techniques can be used for resectability assessment, identification of surgically relevant interindividual anatomic variance and may improve perioperative outcomes. Discussion Three-dimensional reconstruction using computed tomography imaging improves surgical planning and there is evidence that it results in shorter operative times, less intraoperative blood loss and lower rates of surgical conversion, as it can be applied both pre- and intraoperatively.
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Affiliation(s)
- Mats T. Vervoorn
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands,Correspondence: Mats T. Vervoorn
| | - Maaike Wulfse
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Margriet Stellingwerf
- Department of Pulmonology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Niels P. van der Kaaij
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Linda M. de Heer
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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Shao S, Song G, Wang Y, Yi T, Li S, Chen F, Li Y, Liu X, Han B, Liu Y. Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis. Front Oncol 2022; 12:946800. [PMID: 36081555 PMCID: PMC9445983 DOI: 10.3389/fonc.2022.946800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study aimed to conduct a comparative analysis of the survival rates after segmentectomy, wedge resection, or lobectomy in patients with cStage IA lung squamous cell carcinoma (SCC).MethodsWe enrolled 4,316 patients who had cStage IA lung SCC from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards model was conducted to recognize the potential risk factors for overall survival (OS) and lung cancer-specific survival (LCSS). To eliminate potential biases of included patients, the propensity score matching (PSM) method was used. OS and LCSS rates were compared among three groups stratified according to tumor size.ResultsKaplan–Meier analyses revealed no statistical differences in the rates of OS and LCSS between wedge resection (WR) and segmentectomy (SG) groups for patients who had cStage IA cancers. In patients with tumors ≤ 1 cm, LCSS favored lobectomy (Lob) compared to segmentectomy (SG), but a similar survival rate was obtained for wedge resection (WR) and lobectomy (Lob). For patients with tumors sized 1.1 to 2 cm, lobectomy had improved OS and LCSS rates compared to the segmentectomy or wedge resection groups, with the exception of a similar OS rate for lobectomy and segmentectomy. For tumors sized 2.1 to 3 cm, lobectomy had a higher rate of OS or LCSS than wedge resection or segmentectomy, except that lobectomy conferred a similar LCSS rate compared to segmentectomy. Multivariable analyses showed that patients aged ≥75 and tumor sizes of >2 to ≤3 cm were potential risk factors for OS and LCSS, while lobectomy and first malignant primary indicator were considered protective factors. The Cox proportional analysis also confirmed that male patients aged ≥65 to <75 were independent prognostic factors that are indicative of a worse OS rate.ConclusionsThe tumor size can influence the surgical procedure recommended for individuals with cStage IA lung SCC. For patients with tumors ≤1 cm, lobectomy is the recommended approach, and wedge resection or segmentectomy might be an alternative for those who cannot tolerate lobectomy if adequate surgical margin is achievable and enough nodes are sampled. For tumors >1 to ≤3 cm, lobectomy showed better survival outcomes than sublobar resection. Our findings require further validation by randomized controlled trial (RCT) or other evidence.
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Detterbeck FC, Mase VJ, Li AX, Kumbasar U, Bade BC, Park HS, Decker RH, Madoff DC, Woodard GA, Brandt WS, Blasberg JD. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: systematic review of evidence regarding resection extent in generally healthy patients. J Thorac Dis 2022; 14:2357-2386. [PMID: 35813747 PMCID: PMC9264068 DOI: 10.21037/jtd-21-1824] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making.
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Affiliation(s)
- Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Whitlock RS, Burt BM. Commentary: At the intersection of biology and anatomy: Segmentectomy. JTCVS OPEN 2022; 10:368-369. [PMID: 36004245 PMCID: PMC9390242 DOI: 10.1016/j.xjon.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Richard S. Whitlock
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bryan M. Burt
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Peng T, Wightman SC, Ding L, Lieu DK, Atay SM, David EA, Kim AW. Lobectomy offers improved survival outcomes relative to segmentectomy for >2 but ≤4 cm non–small cell lung cancer tumors. JTCVS OPEN 2022; 10:356-367. [PMID: 36004221 PMCID: PMC9390142 DOI: 10.1016/j.xjon.2022.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022]
Abstract
Objective The objective was to compare overall survival (OS) between lobectomy and segmentectomy for patients with non–small cell lung cancers (NSCLCs) > 2 but ≤4 cm. Methods The National Cancer Database was queried to identify treatment-naïve patients with NSCLC tumors >2 but ≤4 cm. Eligible patients were diagnosed with pT1 or T2 N0 M0 disease, underwent lobectomy or segmentectomy, and received no adjuvant therapy. OS was compared using the Kaplan-Meier method, and the Cox proportional-hazards model was used to identify prognostic factors for death. Propensity score matching was performed to minimize the effects of potential confounders. Results Included were 32,792 patients: lobectomy (n = 31,353) and segmentectomy (n = 1439). Five-year OS was improved following lobectomy over segmentectomy for patients with >2 but ≤4 cm NSCLCs (62.3% vs 52.6%; P < .0001). Further stratification demonstrated improved 5-year OS following lobectomy over segmentectomy: >2 but ≤3 cm (64.9% vs 54.3%; P < .0001) and >3 but ≤4 cm (56.9% vs 47.6%; P = .0003). In patients with a Charlson-Deyo comorbidity index of 0, 5-year OS was greater following lobectomy for >2 but ≤4 cm tumors (67.1% vs 62.1%; P = .03). Further stratification demonstrated improved 5-year OS following lobectomy for patients with Charlson-Deyo comorbidity index of 0 and > 3 but ≤4 cm tumors (61.8% vs 54.6%; P = .02). Segmentectomy was prognostic for increased risk of death in the year 1 through 5 postoperative period (hazard ratio, 1.35; P < .0001). Five-year OS remained greater following lobectomy after propensity score matching (59.6% vs 52.7%; P = .02). Conclusions Lobectomy is associated with superior 5-year OS compared with segmentectomy and may be preferred for NSCLC tumors >2 but ≤4 cm when feasible.
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Affiliation(s)
- Terrance Peng
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
| | - Sean C. Wightman
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, Calif
| | - Dustin K. Lieu
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
| | - Scott M. Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
| | - Elizabeth A. David
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
| | - Anthony W. Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
- Address for reprints: Anthony W. Kim, MD, Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St, Suite 514, Los Angeles, CA 90033.
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Wu Z, Huang Z, Qin Y, Jiao W. Progress in three-dimensional computed tomography reconstruction in anatomic pulmonary segmentectomy. Thorac Cancer 2022; 13:1881-1887. [PMID: 35585765 PMCID: PMC9250838 DOI: 10.1111/1759-7714.14443] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
The number of minimally invasive surgeries, such as video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery, has increased enormously in recent years. More and more relevant studies report that anatomic pulmonary segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early stage non-small cell lung cancer (diameter less than 2.0 cm). Segmentectomy requires sufficient knowledge of the location of the pulmonary nodules, as well as the anatomy of the target segments, blood vessels, and bronchi. With the rapid development of imaging technology and three-dimensional technology, three-dimensional reconstruction has been widely used in the medical field. It can effectively assess the vascular branching patterns, discover the anatomic variations of the blood vessels and bronchi, determine the location of the lesion, and clarify the division of the segments. Therefore, it is helpful for preoperative positioning, surgical planning, preoperative simulation and intraoperative navigation, and provides a reference for formulating an individualized surgical plan. It therefore plays a positive role in anatomic pulmonary segmentectomy. This study reviews the progress made in three-dimensional computed tomography reconstruction in anatomic pulmonary segmentectomy.
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Affiliation(s)
- Zhe Wu
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhangfeng Huang
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Qin
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
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Deboever N, Mitchell KG, Feldman HA, Cascone T, Sepesi B. Current Surgical Indications for Non-Small-Cell Lung Cancer. Cancers (Basel) 2022; 14:1263. [PMID: 35267572 PMCID: PMC8909782 DOI: 10.3390/cancers14051263] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/05/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
With recent strides made within the field of thoracic oncology, the management of NSCLC is evolving rapidly. Careful patient selection and timing of multi-modality therapy to permit the optimization of therapeutic benefit must be pursued. While chemotherapy and radiotherapy continue to have a role in the management of lung cancer, surgical therapy remains an essential component of lung cancer treatment in early, locally and regionally advanced, as well as in selected, cases of metastatic disease. Recent and most impactful advances in the treatment of lung cancer relate to the advent of immunotherapy and targeted therapy, molecular profiling, and predictive biomarker discovery. Many of these systemic therapies are a part of the standard of care in metastatic NSCLC, and their indications are expanding towards surgically operable lung cancer to improve survival outcomes. Numerous completed and ongoing clinical trials in the surgically operable NSCLC speak to the interest and importance of the multi-modality therapy even in earlier stages of NSCLC. In this review, we focus on the current standard of care indications for surgical therapy in stage I-IV NSCLC as well as on the anticipated future direction of multi-disciplinary lung cancer therapy.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (N.D.); (K.G.M.); (H.A.F.)
| | - Kyle G. Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (N.D.); (K.G.M.); (H.A.F.)
| | - Hope A. Feldman
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (N.D.); (K.G.M.); (H.A.F.)
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (N.D.); (K.G.M.); (H.A.F.)
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Phillips WW, Gill RR, Mazzola E, Armitage JR, de Forcrand C, Colson YL, Gibney BC. Impact of Nodule Density in Women With Sublobar Resection for Stage IA Adenocarcinoma. Ann Thorac Surg 2021; 112:1067-1075. [DOI: 10.1016/j.athoracsur.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 09/06/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022]
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Dimitrovska NT, Bao F, Yuan P, Hu S, Chu X, Li W. Learning curve for two-port video-assisted thoracoscopic surgery lung segmentectomy. Interact Cardiovasc Thorac Surg 2021; 34:402-407. [PMID: 34480175 PMCID: PMC8922683 DOI: 10.1093/icvts/ivab236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/17/2021] [Accepted: 08/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES When lung cancer evolves from a large, centrally located mass to small, peripherally located pulmonary nodules, such as ground glass nodules, segmentectomy offers a reasonable method by which to save lung parenchyma without eliciting compromising oncological effects. To master these techniques, it is important to analyse the learning curve of surgeons. Therefore, the aim of the present study was to analyse the learning curve for two-port video-assisted thoracoscopic surgery (VATS) segmentectomy in our institution. METHODS We retrospectively collected data from 86 consecutive patients who underwent two-port VATS segmentectomy between June 2019 and November 2019. The operative time (OT) and estimated blood loss and other complications were analysed. The learning curve was evaluated using the OT and the cumulative sum (CUSUM) value of OTs across all cases. RESULTS We generated a graph of the CUSUM of OTs and found that the learning curve could be differentiated into 3 phases: phase 1, the initial learning phase (1st to 27th operation); phase 2, the increased competence phase (28th to 54th operation); and phase 3, the experienced phase (55th to 86th operation). The CUSUM value inflected at patient number 47. There were significant reductions in the OT and bleeding in phase 3 relative to phases 1 and 2. There were also significant differences in OT and estimated blood loss between the simple and complex segmentectomy procedures. CONCLUSIONS In conclusion, the 3 phases identified using CUSUM analysis of the OT represented characteristic stages of the learning curve for two-port VATS segmentectomy. The data indicate that, in our institution, the inflection point for the learning curve was achieved after operating on 47 cases.
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Affiliation(s)
- Natasha Toleska Dimitrovska
- Department of Thoracic Surgery, University Clinic for Thoracic and Vascular Surgery, Skopje, Macedonia, The Former Republic of Yugoslavia
| | - Feichao Bao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai, China
| | - Ping Yuan
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shoujun Hu
- Department of Thoracic Surgery, Fuyang People's Hospital, Fuyang, Anhui, China
| | - Xiao Chu
- Department of Thoracic Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wentao Li
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai, China
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Zhou B, Xu X, Dai J, Guo Y, Jin K, Zhu Y, Wang H, Jiang G. Propensity-matched Comparison of VATS Left Upper Tri-segmentectomy and Lobectomy. Ann Thorac Surg 2021; 114:1007-1014. [PMID: 34428431 DOI: 10.1016/j.athoracsur.2021.07.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/22/2021] [Accepted: 07/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study aims to investigate the oncological outcomes of video-assisted thoracoscopic (VATS) left upper tri-segmentectomy (LTS) versus left upper lobectomy (LUL) for patients presenting with stage I non-small-cell lung cancer (NSCLC). METHODS A retrospective analysis identified 1543 consecutive patients presenting to Shanghai Pulmonary Hospital with NSCLC for VATS-LTS or LUL from 2013-2017. After propensity-score matching for patient demographics and tumor characteristics, 273 pairs were identified. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the Log-rank test. RESULTS The median follow-up time was 51.5 months. There were no significant differences in operative duration (2.11±0.64 versus 2.49±5.96 h, p=0.30), total blood loss (106.19±170.83 versus 97.07±149.34 mL, p=0.51) and operation complications (10% versus 8%, p=0.37) between LUL and LTS. Patients undergoing LUL had longer postoperative hospital stay (5.55±3.00 versus 4.87±2.33 days, p=0.003), greater tumor margin distance (3.3±1.2 versus 3.1±0.9 cm, p<.001) and greater number of lymph nodes harvested (8.0±3.2 versus 6.8±3.3, p<.001) than LTS, but the margin/tumor ratio was not statistically different (2.5±1.6 versus 2.3±1.1, p=0.11). Median DFS (49.5 versus 54.3 months, p=0.77) and OS (49.5 versus 55.0 months, p=0.88) were not significantly different between patients undergoing LTS and LUL, and similar outcomes were noted across subgroups of patients stratified by tumor stages, pathological type, and radiographic manifestations. CONCLUSIONS VATS-LTS and LUL had comparable oncological outcomes for stage I NSCLC, regardless of tumor pathological types and radiological findings, as long as negative margins were confirmed.
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Affiliation(s)
- Bin Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Xiaoxiong Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Yanhua Guo
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Kaiqi Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - HaiFeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China.
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22
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Winckelmans T, Decaluwé H, De Leyn P, Van Raemdonck D. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 57:1051-1060. [PMID: 31898738 DOI: 10.1093/ejcts/ezz339] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/24/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The role of segmentectomy in early-stage non-small-cell lung cancer (NSCLC) remains a matter of debate. We performed a meta-analysis to evaluate the oncological outcomes following segmentectomy versus lobectomy for stage I, stage IA only and stage IA <2 cm only. METHODS We systematically searched the literature for articles reporting on overall survival (OS), cancer-specific survival (CSS) or recurrence-free survival (RFS). The hazard ratios (HRs) were retrieved and pooled using an inverse variance-weighted approach. RESULTS Twenty-eight studies were included in the analysis. In stage I, segmentectomy was found to be inferior to lobectomy for all 3 outcomes with HR: 1.25 (P = 0.01) for OS, 1.59 (P = 0.02) for CSS and 1.40 (P < 0.001) for RFS. In stage IA, the differences were significant for OS and CSS, though not for RFS with HR: 1.31 (P = 0.04), 1.56 (P = 0.02) and 1.22 (P = 0.11), respectively. In stage IA <2 cm, no significant differences were found between segmentectomy and lobectomy with HR: 1.13 (P = 0.37) for OS, 1.02 (P = 0.95) for CSS and 1.24 (P = 0.11) for RFS. CONCLUSIONS For stages I and IA, lobectomy showed superior results whereas for tumours <2 cm, our study did not find significant differences in oncological outcomes between both groups. These results suggest that segmentectomy might be a valuable alternative to lobectomy for NSCLC in tumours <2 cm.
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Affiliation(s)
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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23
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Bao F, Dimitrovska NT, Hu S, Chu X, Li W. Safety of early discharge with a chest tube after pulmonary segmentectomy. Eur J Cardiothorac Surg 2021; 58:613-618. [PMID: 32236542 DOI: 10.1093/ejcts/ezaa097] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon's experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2-32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.
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Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Thoracic Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Shoujun Hu
- Department of Thoracic Surgery, Fuyang People's Hospital, Fuyang, Anhui, China
| | - Xiao Chu
- Department of Thoracic Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wentao Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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24
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Berg E, Madelaine L, Baste JM, Dahan M, Thomas P, Falcoz PE, Martinod E, Bernard A, Pagès PB. Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study. J Thorac Dis 2021; 13:3587-3596. [PMID: 34277052 PMCID: PMC8264688 DOI: 10.21037/jtd-20-2203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anatomical segmentectomy is an alternative to lobectomy for early-stage lung cancer (LC) or in patients at high risk. The main objective of this study was to compare the morbidity and mortality associated with these two types of pulmonary resection using data from the French National Epithor database. METHODS All patients who underwent lobectomy or segmentectomy for early-stage LC from January 1st 2014 to December 31st 2016 were identified in the Epithor database. The primary endpoint was morbidity; the secondary endpoint was postoperative mortality. Propensity score matching was implemented and used to balance groups. The results were reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS During the study period, 1,604 segmentectomies (9.78%) and 14,786 lobectomies (90.22%) were performed. After matching, the segmentectomy group experienced significantly less atelectasis (OR 0.54; 95% CI: 0.4-0.75, P<0.0001), pneumonia (OR 0.72; 95% CI: 0.55-0.95, P=0.02), prolonged air leaks (OR 0.75; 95% CI: 0.64-0.89, P=0.001) or bronchopleural fistula (OR 0.35; 95% CI: 0.14-0.83, P=0.017), and fewer patients had at least one complication (OR 0.7; 95% CI: 0.62-0.78, P<0.0001). According to the Clavien-Dindo classification, postoperative complications were significantly less severe in the segmentectomy group (OR 0.52; 95% CI: 0.37-0.74, P<0.0001). There was no significant difference in postoperative mortality at 30 days (OR 0.67; 95% CI: 0.38-1.20, P=0.18), 60 days (OR 0.78; 95% CI: 0.42-1.47, P=0.4), or 90 days (OR 0.77; 95% CI: 0.45-1.34, P=0.36). CONCLUSIONS Anatomical segmentectomy is an alternative surgical approach that could reduce postoperative morbidity, but it does not appear to affect mortality.
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Affiliation(s)
- Elodie Berg
- CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France
| | | | | | | | | | | | | | - Alain Bernard
- CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France
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25
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Kirschbaum A, Ivanovic A, Wiesmann T, Mirow N, Meyer C. Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model. Lasers Med Sci 2021; 37:815-820. [PMID: 33891211 PMCID: PMC8918094 DOI: 10.1007/s10103-021-03312-2] [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: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022]
Abstract
If a pulmonary pathology can be removed by anatomical segmentectomy, the need for lobectomy is obviated. The procedure is considered oncologically equivalent and saves healthy lung tissue. In every segmentectomy, lung parenchyma must be transected in the intersegmental plane. Using an ex vivo model based on porcine lung, three transection techniques (monopolar cutter + suture, stapler, and Nd:YAG laser) are to be compared with respect to their initial airtightness. At an inspiratory ventilation pressure of 25 mbar, all three preparations were airtight. Upon further increase in ventilation pressure up to 40 mbar, the laser group performed best in terms of airtightness. Since thanks to its use of a laser fibre, this technique is particularly suitable for minimally invasive surgery; it should be further evaluated clinically for this indication in the future.
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Affiliation(s)
- Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany.
| | - Andrijana Ivanovic
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany
| | - Thomas Wiesmann
- Department of Anaesthesiology, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany
| | - Nikolas Mirow
- Department of Cardiac Surgery, University Hospital Gießen and Marburg (UKGM), Marburg site, Baldingerstraße, D-35043, Marburg, Germany
| | - Christian Meyer
- Department of Surgery, Asklepios Stadtklinik Bad Wildungen, Bad Wildungen, Germany
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26
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Wang B, Zhou Y, Jia M, Yan Z, Chen J, Lu X, Wu R, Wen J. Choice of Treatment for Patients With Non-small-cell Lung Cancer >5 cm Between Surgery Alone and Surgery Plus Adjuvant Radiotherapy. Front Surg 2021; 8:649802. [PMID: 33768112 PMCID: PMC7985264 DOI: 10.3389/fsurg.2021.649802] [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: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background: According to the lung cancer staging project, T2b (>5–7 cm) and T3 (>7 cm) non-small cell lung cancers (NSCLC) should be reclassified into T3 and T4 groups. The objective of this study was to evaluate the effect of surgery alone or surgery plus adjuvant radiation (SART) on survival of node-negative patients with NSCLC >5 cm. Methods: We identified 4557 N0 patients with NSCLC >5 cm in the Surveillance, Epidemiology, and End Results database from 2004 to 2014. Overall survival (OS) and cancer–specific survival (CSS) were compared among patients who underwent surgery alone and SART. The proportional hazards model was applied to evaluate multiple prognostic factors. Results: 1,042 and 525 patients who underwent surgery alone and SART, respectively were enrolled after propensity-score matching. OS and CSS favored surgery alone rather than SART. Multivariate analysis showed that the number of lymph nodes examined more than six was associated with better OS and CSS for NSCLC >5 cm, especially in patients treated with surgery alone. Lobectomy should be recommended as the primary option for NSCLC >5 to 7 cm, whereas its superiority was not significant over sublobectomy for NSCLC >7 cm. Conclusion: Surgery alone should be recommended as the first choice for patients with NSCLC >5 cm. The number of examined lymph nodes should be more than six in patients with NSCLC >5 cm, especially for those who undergo surgery alone. For patients with NSCLC >7 cm who could not tolerate lobectomy, sublobectomy might be an alternative surgical procedure.
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Affiliation(s)
- Boyan Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Yongjie Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min Jia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiayan Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Xueguan Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruiyan Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junmiao Wen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China
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27
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Kuroda H, Sakata S, Takahashi Y, Nakada T, Oya Y, Sugita Y, Sakakura N, Matushita H, Sakao Y. Subsegmental resection preserves regional pulmonary function: A focus on thoracoscopy. Thorac Cancer 2021; 12:1033-1040. [PMID: 33586330 PMCID: PMC8017248 DOI: 10.1111/1759-7714.13841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to evaluate regional postoperative preserved pulmonary function (PPPF) and three‐dimensional (3D) volumetric changes according to the number of resected subsegments and investigate the factors that most affected pre‐/post PPPF. Methods Patients who underwent thoracoscopic lobectomy (n = 73), and segmentectomy (n = 87) were eligible for inclusion in the study. They were classified according to the number of resected subsegments which ranged from 1 to 10. The percentage of pre‐/postoperative forced expiratory volume in 1 s (FEV1) was used for comparison. Furthermore, lung volumetric changes were calculated using 3D computed tomography (CT) volumetry. Results The percentage of pre‐/postoperative EFV1 between 4 and 5–7 and between 5–7 and 10 were significant (p = 0.03 and p < 0.01, respectively), but not between 1–2 to 4 (p = 0.99). The difference between volumetric changes in the left lower lobe of patients with a number of resected subsegments was significant (p < 0.01). On univariate and multivariate analyses, chronic inflammation was significant for decrease in recovery percentages. When the PPPF was compared among resected subsegments, it gradually decreased with an increase in the number of patients without a postoperative procrastination of inflammation (p < 0.01). Conclusions Segmentectomy is feasible and useful for PPPF. Even a relatively large‐volume resection procedure where 5–7 subsegments are resected can preserve pulmonary function. Chronic inflammation was statistically identified as a risk factor for postoperative preserved pulmonary function. Key points
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Affiliation(s)
- Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shozo Sakata
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Translational Oncoimmunology, Aichi Cancer Research Institute, Nagoya, Japan
| | - Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuko Oya
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Sugita
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroakazu Matushita
- Department of Translational Oncoimmunology, Aichi Cancer Research Institute, Nagoya, Japan
| | - Yukinori Sakao
- Department of Surgery, Division of Thoracic Surgery, The Teikyo University, Tokyo, Japan
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28
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Gergen AK, White AM, Mitchell JD, Meguid RA, Fullerton DA, Scott CD, Weyant MJ. Introduction of robotic surgery leads to increased rate of segmentectomy in patients with lung cancer. J Thorac Dis 2021; 13:762-767. [PMID: 33717548 PMCID: PMC7947503 DOI: 10.21037/jtd-20-2249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Pulmonary segmentectomy provides an anatomic lung resection while avoiding removal of excess normal lung tissue. This may be beneficial in patients with minimal pulmonary reserve who present with early-stage non-small cell lung cancer (NSCLC). However, the operative performance of a segmentectomy using a video-assisted thoracoscopic approach can be technically challenging. We hypothesized that introduction of the robotic surgical system would facilitate the performance of a segmentectomy as measured by an increase in the proportion of segmentectomies being pursued. Methods We completed a retrospective analysis of thoracoscopic and robotic anatomic lung resections, including lobectomies and segmentectomies, performed in patients with primary lung cancer from the time of initiation of the robotic thoracic surgery program in November 2017 to November 2019. We compared the proportion of thoracoscopic and robotic segmentectomies performed during the first year compared to the second year of the data collection period. Results A total of 138 thoracoscopic and robotic anatomic lung resections were performed for primary lung cancer. Types of lung cancer resected (adenocarcinoma, squamous cell carcinoma, or other), tumor size based on clinical T staging (T1–T4), and tumor location were not significantly different between years (P=0.44, P=0.98, and P=0.26, respectively). The proportion of segmentectomies increased from 8.6% during the first year to 25.0% during the second year (P=0.01). One out of 6 (16.7%) segmentectomies were performed using the robot during the first year versus 15 out of 17 (88.2%) during the second year (P=0.003). Conclusions Use of the robot led to a significant increase in the number of segmentectomies performed in patients undergoing anatomic lung resection. With increasing lung cancer awareness and widely available screening, a greater number of small, early-stage tumors suitable for segmentectomy will likely be detected. We conclude that robotic-assisted surgery may facilitate the challenges of performing a minimally invasive segmentectomy.
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Affiliation(s)
- Anna K Gergen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Allana M White
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - John D Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research (ACCORDS), University of Colorado, Aurora, CO, USA
| | - David A Fullerton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Christopher D Scott
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Michael J Weyant
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
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29
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Zhang W, Chen L, Wang J, Wen W, Xu X, Zhu Q. [A Study on the Authenticity of Preoperative Pulmonary Bronchial Angiography by DeepInsight Software]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:88-93. [PMID: 33478197 PMCID: PMC7936079 DOI: 10.3779/j.issn.1009-3419.2021.104.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Precise segmentectomy has become the first choice of surgical treatment for pulmonary nodules and early lung cancer, and the key and difficult point of the surgery lies in the precise location and resection of the lesion. DeepInsight is an auxiliary software for precise lung surgery jointly developed by our center and Neusoft Company, which can determine the precise anatomy of the lung and locate the location of lung lesions before operation. This study is to verify the authenticity and reliability of DeepInsight lung bronchial angiography assisted surgery. METHODS In this study, 1,020 patients with pulmonary nodules <2.0 cm in diameter were included in the Department of Thoracic Surgery Jiangsu Provincial People's Hospital from August 1, 2016 to December 31, 2019. Computed tomographic angiography (CTA) was performed on all the included patients before surgery. The DeepInsight software was used to perform preoperative bronchial angiography on the operative side of the lung to identify the affected pulmonary segments, pulmonary arteries and pulmonary veins. Two thoracic surgeons independently assessed the visibility of the affected pulmonary vessels using the 5-point method, and the χ² test assessed the consistency between observers. In addition, virtual imaging and real anatomy of pulmonary vessels on the operative side were performed during the operation, and the involved pulmonary vessels were finally determined by 2 chief physicians of thoracic surgery. RESULTS There were no statistically significant differences between the number and spatial anatomy of the vessels involved in the pulmonary virtual imaging using DeepInsight software before operation and the number of vessels involved during operation in 1,020 patients. And the consistency among observers is quite satisfactory. CONCLUSIONS The DeepInsight software virtual imaging of pulmonary bronchial vessels can accurately reconstruct the actual pulmonary vessels and assist the completion of pulmonary segmental resection.
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Affiliation(s)
- Wang Zhang
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Liang Chen
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Wang
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Wen
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xinfeng Xu
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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30
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Darras M, Ojanguren A, Forster C, Zellweger M, Perentes JY, Krueger T, Gonzalez M. Short-term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm. Thorac Cancer 2020; 12:453-461. [PMID: 33270380 PMCID: PMC7882390 DOI: 10.1111/1759-7714.13766] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction VATS pulmonary segmentectomy is increasingly proposed as a parenchyma‐sparing resection for tumors smaller than 2 cm in diameter. The aim of this study was to compare short‐term oncological results and local control in solid non‐small cell lung cancers (NSCLCs) <2 cm surgically treated by intentional VATS segmentectomy or lobectomy. Methods This study was a single center retrospective study of consecutive patients undergoing VATS lobectomy (VL) or segmentectomy (VS) for solid <2 cm NSCLC from January 2014 to October 2019. Results In total, 188 patients with a median age of 65 years (male/female: 99/89) underwent VS (n = 96) or VL (n = 92). Segmentectomies in the upper lobes were performed in 57% and as a single segment in 55% of cases. There was no statistically significant difference between VS and VL in terms of demographics, comorbidities, postoperative outcomes, dissected lymph node stations (2.89 ± 0.95 vs. 2.93 ± 1, P = 0.58), rate of pN1 (2.2% vs. 2.1%, P = 0.96) or pN2 upstaging (1.09% vs. 1.06%, P = 0.98). Adjuvant chemotherapy was given in 15% of patients in the VL and 11% in the VS group. During follow‐up (median: 23 months), no patients presented with local nodal recurrence or on the stapler line (VS group). Three patients on VL and two in VS groups presented with recurrence on the remnant operated lung. New primary pulmonary tumors were diagnosed in 3.3% and 6.3% of patients in the VL and VS groups, respectively. Conclusions Despite the short follow‐up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy for patients with NSCLC <2 cm.
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Affiliation(s)
- Marc Darras
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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Surgical Outcomes of Lobectomy Versus Limited Resection for Clinical Stage I Ground-Glass Opacity Lung Adenocarcinoma 2 Centimeters or Smaller. Clin Lung Cancer 2020; 22:e160-e168. [PMID: 33160898 DOI: 10.1016/j.cllc.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 09/23/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND To compare the surgical outcomes of patients with clinical stage I ground-glass opacity (GGO) lung adenocarcinomas with maximum diameters of ≤ 2 cm who underwent lobectomy versus limited resection. PATIENTS AND METHODS We retrospectively reviewed cases of clinical stage I GGO lung adenocarcinoma with a diameter ≤ 2 cm that were treated via lobectomy or limited resection in our department between January 2011 and September 2018. The clinical characteristics and surgical outcomes were analyzed using a propensity score-matched comparison and a Cox regression model. RESULTS A total of 552 patients were identified; 128 patients with pure GGO were excluded. Four hundred twenty-four patients met our criteria, including 242 (57.1%) who underwent lobectomy and 182 (42.9%) who underwent limited resection. No perioperative mortality occurred in either group. The overall 5-year survival rate of the entire cohort was 88%. Patients who underwent limited resection tended to have a shorter operation time, smaller blood loss volume, fewer removed nodes, and a shorter postoperative stay. However, the groups did not differ in terms of postoperative complications. Lobectomy and limited resection could lead to equivalent overall survival in patients with GGO-dominant tumor, while lobectomy showed better overall survival than limited resection in patients with solid-dominant tumor. CONCLUSION Patients with small GGO lung adenocarcinoma had a favorable prognosis after surgery. The oncologic surgical procedures of lobectomy and limited resection yielded comparable outcomes in patients with clinical stage I GGO-dominant lung adenocarcinomas ≤ 2 cm, while lobectomy showed better survival than limited resection in patients with solid-dominant tumor.
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饶 孙, 叶 联, 崔 欣, 孙 芩, 曹 润, 肖 寿, 杨 继, 王 维, 赵 光, 黄 云. [Progress in Survival Prognosis of Segmentectomy for
Early-stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:830-836. [PMID: 32957171 PMCID: PMC7519961 DOI: 10.3779/j.issn.1009-3419.2020.102.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
Surgery is currently the most appropriate treatment for early-stage non-small cell lung cancer (NSCLC). Increasing unilateral or bilateral multiple primary lung cancer being found, segmentectomy has attracted wide attention for its unique advantages in the treatment for such tumors. Ground glass opacity dominant early-stage NSCLC is associated with a good prognosis and can be cured by segmentectomy, however, the treatment of solid-dominant NSCLC remains controversial owing to the invasive nature. With the in-depth study on the lymph node metastasis pathway, radiological characteristics and molecular biology of NSCLC, a large part of solid nodules with certain characteristics can also be cured by segmentectomy. This paper reviews the research status and progress about the indication of segmentectomy.
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Affiliation(s)
- 孙银 饶
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 联华 叶
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 欣 崔
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 芩玲 孙
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 润 曹
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 寿勇 肖
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 继琛 杨
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 维 王
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 光强 赵
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 云超 黄
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
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Blakely AM, Hu H, Wong FL, Raz D, Erhunmwunsee L, Kim JY, Sun V. Deterioration in health-related quality of life is associated with lower lung resection rates in older adults. J Geriatr Oncol 2020; 12:422-427. [PMID: 32933871 DOI: 10.1016/j.jgo.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/10/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lung cancer disproportionately affects older adults. Surgical treatment may result in decreased functional status and health-related quality of life (HRQOL). Population-based data about patient-reported health outcomes for patients with early-stage lung cancer who do not undergo surgery is lacking. METHODS We identified lung cancer patients with localized disease from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. Patients with baseline HRQOL survey prior to cancer diagnosis and follow-up survey ≥1 year after diagnosis were selected. Generalized estimating equation (GEE) model was used to compare patients who underwent surgery versus those who did not by demographics and HRQOL measures. RESULTS Overall, 108 patients were evaluated, of whom 75 (69%) underwent surgery. Surgical patients were younger (mean 73 versus 80 years, p < 0.001); otherwise, patient groups were similar. Surgery was not performed based on surgeon recommendation (n = 21, 64%), contraindication(s), or patients' decision. Both groups experienced similar declines in physical HRQOL, mental HRQOL, and activities of daily living (ADL) scores; and increased major comorbidities. However, non-surgical patients had significant declines in mobility and personal care activities compared to surgical counterparts. On GEE, non-surgical patients were significantly more likely to experience an increase in number of comorbidities (OR 3.3, p = 0.02) compared to surgical patients. CONCLUSIONS Patients undergoing lung cancer surgery experience significant declines in functional status and HRQOL. However, similar declines are seen in non-surgical patients. More information is needed about long term QOL trajectories with and without surgery so that patients and surgeons can make informed decisions balancing survival benefit and QOL interests.
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Affiliation(s)
- Andrew M Blakely
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | - Hengrui Hu
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Dan Raz
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Jae Y Kim
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Virginia Sun
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA; Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
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Abdellateef A, Ma X, Qiao W, Chen Z, Wu L, Cai J, Jiang L. Subxiphoid uniportal video-assisted thoracoscopic pulmonary segmentectomy: effect of learning curve and future perspectives. Eur J Cardiothorac Surg 2020; 58:i50-i57. [PMID: 32613248 DOI: 10.1093/ejcts/ezaa101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/11/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Subxiphoid uniportal video-assisted thoracoscopic segmentectomy (SU-VATs) has been widely adopted because it is associated with better postoperative pain scores. Nevertheless, it also has had some limitations that have gradually been decreasing. Therefore, our goal was to evaluate the change in perioperative results with SU-VATs as the learning curve developed to outline the current status and the points that should be of future concern. METHODS Three hundred patients who underwent SU-VATs from September 2014 to May 2018 were divided chronologically into 2 groups; group 1 comprised the first 150 cases and group 2 comprised the last 150 cases. Different perioperative variables were analysed and compared between the 2 groups. In addition, the cumulative sum analysis and multivariable logistic regression were conducted to identify the cut-off point and predictors of significant improvement in operative time. RESULTS The cumulative sum analysis showed significant improvement in the operative time after the 148th case. Group 2 showed a statistically significant decrease in operative time (104.3 ± 36.7 vs 132 ± 43.1 min; P < 0.001), amount of operative blood loss [50 (80 ml) vs 100 (50 ml); P < 0.001], chest drain duration (2.6 ± 1.6 vs 3.2 ± 1.4 days; P = 0.004) and hospital stay (3.7 ± 1.7 vs 4.2 ± 1.7 days; P = 0.008). The number of dissected lymph nodes was significantly higher in the second group [11 (4) vs 9 (4); P < 0.001]. CONCLUSIONS Limitations of SU-VATs are being overcome by the improvement in the learning curve and in the expertise of the surgeons. Our future concerns should focus on examining the long-term survival rate, the oncological efficacy and the effect on quality of life.
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Affiliation(s)
- Amr Abdellateef
- Department of Cardiothoracic Surgery, Mansoura University Hospital, Mansoura University School of Medicine, Mansoura, Egypt.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyu Ma
- Thoracic Surgery Department, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wenxiang Qiao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhigang Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianqiao Cai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Deterioration in Health-Related Quality of Life Diminishes Benefit of Lung Cancer Resection in Older Adults. Clin Lung Cancer 2020; 22:e544-e551. [PMID: 32727705 DOI: 10.1016/j.cllc.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Outcomes of oncologic resection are related to tumor biology and patient-reported health factors. However, data regarding changes in functional status and health-related quality of life (HRQOL) before and after lung surgery for older adults are lacking. PATIENTS AND METHODS We identified lung cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL surveys captured physical/mental health, activity of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with baseline prediagnosis HRQOL survey and postdiagnosis follow-up survey were selected. Patient, disease, and HRQOL measures were analyzed by Cox proportional hazards regression for overall and disease-specific survival. RESULTS Overall, 138 patients were evaluated. Disease extent was localized for 75 (54%) and regional for 58 (42%). The cohort experienced an increase in the number of major comorbidities and declines in physical HRQOL, mental HRQOL, and ADLs. Median overall survival was 74 months. Decreased overall survival was independently associated with male sex (hazard ratio [HR] = 1.7, P = .03), more advanced disease (regional vs. localized: HR = 1.8, P = .01; distant vs. localized: HR = 2.1, P = .22), and decline in ADLs (HR = 1.8, P = .02). Decreased disease-specific survival was independently associated with male sex (HR = 2.2, P = .03), more advanced disease (regional vs. localized: HR = 2.9, P = .002; distant vs. localized: HR = 3.1, P = .22), and decline in mental HRQOL (odds ratio = 2.1, P = .02). CONCLUSION The potential survival benefit of lung resection for malignancy is diminished by declines in physical and mental health. Among older surgical patients at risk for functional and HRQOL deterioration, identification and mitigation of such deterioration may optimize oncologic outcomes.
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Fan X, Liang Y, Bai Y, Yang C, Xu S. Conditional survival rate estimates of lobectomy, segmentectomy and wedge resection for stage IA1 non-small cell lung cancer: A population-based study. Oncol Lett 2020; 20:1607-1618. [PMID: 32724402 PMCID: PMC7377117 DOI: 10.3892/ol.2020.11713] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/27/2020] [Indexed: 11/06/2022] Open
Abstract
Conditional survival rate (CSR) is defined as the dynamic possibility of survival, considering the changes in the survival risk over time. The present study aimed to compare the CSR of the surgical procedures for stage IA1 non-small cell lung cancer (NSCLC). Overall, data for 2,535 patients with stage IA1 NSCLC after lobectomy, segmentectomy or wedge resection were obtained from the Surveillance, Epidemiology and End Results database, and the overall survival (OS) rates were subsequently compared. CSR estimates, the possibility of patients who had already survived × years, to survive further y years, was calculated as CSR=S(x+y)/S(x), where S is the survival rate at a particular point in time. A Cox regression model and propensity-score matching were used to adjust confounding factors. There were no statistical differences in the OS among the three surgical procedures, except that OS of patients who underwent a lobectomy was improved compared with the wedge resection. The CSR of surviving to the 5th year after operation improved gradually over time. The 3-year CSR of lobectomy or segmentectomy was higher compared with that of the wedge resection. Moreover, the 3-year CSR of segmentectomy was higher compared with that of lobectomy from the 3rd year after surgery, particularly in some specific situations, such as female sex, patients ≥66 years old, patients with squamous cell carcinoma or patients with poor tumor differentiation. The present study is the first report to compare CSR following lobectomy, segmentectomy and wedge resection for patients with stage IA1 NSCLC, to the best of our knowledge. These findings indicated that lobectomy is the most conservative surgical procedure for stage IA1 NSCLC and raises questions regarding improved long-term prognosis of segmentectomy in some subsets of patients.
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Affiliation(s)
- Xiaoxi Fan
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yicheng Liang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yunpeng Bai
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Chunlu Yang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Shun Xu
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Hao B, Zhang L, Fan T, Liu B, Jiang W, Hu H, Geng Q. Survival Following Segmentectomy or Lobectomy in Patients With Stage IB Non-small-cell Lung Cancer. Front Oncol 2020; 10:661. [PMID: 32500023 PMCID: PMC7243118 DOI: 10.3389/fonc.2020.00661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Lobectomy with mediastinal lymph node dissection has always been recognized as the standardized treatment for early-stage non-small-cell lung cancer. However, the feasibility of segmentectomy performed in stage IB non-small-cell lung cancer (NSCLC) patients remains controversial. The present study aims to investigate whether the outcome of stage IB NSCLC patients undergoing segmentectomy was comparable to those who underwent lobectomy. Method: We retrospectively collected data of 11,010 patients with primary stage IB non-small-cell lung cancer from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and lung cancer-specific survival (LCSS) were assessed among patients who were performed lobectomy or segmentectomy. To further assess the impact of the surgical procedures on patients with different tumor sizes, subgroups stratified by tumor size were analyzed. Results: A total of 11,010 patients who were pathologically confirmed to be stage IB were included, of whom 10,453 received lobectomy and 557 received segmentectomy. Both univariate and multivariate Cox regression analyses showed that the patients receiving lobectomy had better OS [hazards ratio (HR) = 1.197, 95% confidence interval (CI) (1.066, 1.343), P < 0.001] than those receiving segmentectomy. However, multivariate analysis showed that there was no significant difference in LCSS between lobectomy and segmentectomy [HR = 1.172, 95% CI (0.963, 1.427), P = 0.114]. Meanwhile, subgroup analyses showed that lobectomy rather than segmentectomy was associated with better OS [HR = 1.278, 95% CI (1.075, 1.520) P = 0.006] and LCSS [HR = 1.118, 95% CI (1.005, 1.280), P = 0.047] for patients with a tumor size (TS) of ≤ 40 and >30 mm, while for patients with a TS of ≤ 30 mm, lobectomy yielded similar OS [TS ≤ 20 mm: HR = 1.068, 95% CI (0.853, 1.336), P = 0.566; TS > 20 mm and ≤ 30 mm: HR = 1.195, 95% CI (0.961, 1.487), P = 0.109] and LCSS [TS ≤ 20 mm: HR = 1.029, 95% CI: (0.682, 1.552), P = 0.893; TS > 20 and ≤ 30 mm: HR = 1.144, 95% CI (0.795, 1.645), P = 0.469] to that of segmentectomy. Conclusion: Segmentectomy achieved equivalent OS and LCSS in stage IB NSCLC patients with TS ≤ 30 mm compared with lobectomy. Lobectomy showed better OS and LCSS than segmentectomy for patients with a TS of >30 and ≤ 40 mm. Segmentectomy may be acceptable in patients with an older age and a smaller TS.
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Affiliation(s)
- Bo Hao
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lin Zhang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tao Fan
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bohao Liu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenyang Jiang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hao Hu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Chan JWY, Yu PSY, Lau RWH, Ng CSH. Hybrid operating room-one stop for diagnosis, staging and treatment of early stage NSCLC. J Thorac Dis 2020; 12:123-131. [PMID: 32190362 DOI: 10.21037/jtd.2019.08.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
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39
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Zeng W, Zhang W, Zhang J, You G, Mao Y, Xu J, Yu D, Peng J, Wei Y. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage I non-small cell lung cancer. World J Surg Oncol 2020; 18:44. [PMID: 32106856 PMCID: PMC7047378 DOI: 10.1186/s12957-020-01814-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether video-assisted thoracoscopic surgery (VATS) segmentectomy and VATS lobectomy provide similar perioperative and oncological outcomes in stage I non-small cell lung cancer (NSCLC) is still controversial. METHODS Meta-analysis of 12 studies comparing outcomes after VATS lobectomy and VATS segmentectomy for stage I NSCLC. Data were analyzed by the RevMan 5.3 software. RESULTS Disease-free survival (HR 1.19, 95% CI 0.89 to 1.33, P = 0.39), overall survival (HR 1.11, 95% CI 0.89 to 1.38, P = 0.36), postoperative complications (OR = 1.10, 95% CI 0.69 to 1.75, P = 0.7), intraoperative blood loss (MD = 3.87, 95% CI - 10.21 to 17.94, P = 0.59), operative time (MD = 10.89, 95% CI - 13.04 to 34.82, P = 0.37), air leak > 5 days (OR = 1.20, 95% CI 0.66 to 2.17, P = 0.55), and in-hospital mortality (OR = 1.67, 95% CI 0.39 to 7.16, P = 0.49) were comparable between the groups. Postoperative hospital stay (MD = - 0.69, 95% CI - 1.19 to - 0.19, P = 0.007) and number of dissected lymph nodes (MD = - 6.44, 95%CI - 9.49 to - 3.40, P < 0.0001) were significantly lower in VATS segmentectomy patients. CONCLUSIONS VATS segmentectomy and VATS lobectomy provide similar oncological and perioperative outcomes for stage I NSCLC patients. This systematic review was registered on PROSPERO and can be accessed at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID = CRD42019133398.
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Affiliation(s)
- Weibiao Zeng
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianyong Zhang
- Department of General Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Guangmiao You
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu'ang Mao
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianjun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongliang Yu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinhua Peng
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiping Wei
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
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Gálvez C, Bolufer S, Gálvez E, Navarro-Martínez J, Galiana-Ivars M, Sesma J, Rivera-Cogollos MJ. Anatomic Segmentectomy in Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2020; 30:61-72. [PMID: 31761285 DOI: 10.1016/j.thorsurg.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thoracic surgery has evolved into minimally invasive surgery, in terms of not only surgical approach but also less aggressive anesthesia protocols and lung-sparing resections. Nonintubated anatomic segmentectomies are challenging procedures but can be safely performed if some essentials are considered. Strict selection criteria, previous experience in minor procedures, multidisciplinary cooperation, and the 4 cornerstones (deep sedation, regional analgesia, oxygenation support and vagal blockade) should be followed. Better outcomes in postoperative recovery, including resumption of oral intake, chest tube duration, and hospital stay, and low complication and conversion rates, are encouraging but should be checked in larger multicenter prospective randomized trials.
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Affiliation(s)
- Carlos Gálvez
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Elisa Gálvez
- Medical Oncology, Hospital General Universitario Elda, Ctra. Sax- La Torreta, S/N, Elda, Alicante 03600, Spain
| | - Jose Navarro-Martínez
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Maria Galiana-Ivars
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - María Jesús Rivera-Cogollos
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
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41
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Sihoe AD. Surgical management of ground glass opacities of the lung. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alan D.L. Sihoe
- School of Biomedical SciencesThe University of Hong Kong Hong Kong SAR China
- Gleneagles Hong Kong Hospital Hong Kong SAR China
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Shiina Y, Nakajima T, Yamamoto T, Tanaka K, Sakairi Y, Wada H, Suzuki H, Yoshino I. The D-dimer level predicts the postoperative prognosis in patients with non-small cell lung cancer. PLoS One 2019; 14:e0222050. [PMID: 31877562 PMCID: PMC6932866 DOI: 10.1371/journal.pone.0222050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/19/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Carcinoma cells often modulate coagulation and fibrinolysis among cancer patients. Plasma dimerized plasmin fragment D (D-dimer) has been reported as a prognostic marker of various types of malignancies, including non-small cell lung cancer (NSCLC). However, the associations between the plasma D-dimer level and peripheral small NSCLC remain unclear. METHODS Three hundred and sixty-two patients with NSCLC who underwent radical surgery were retrospectively reviewed. Patients who received anticoagulation therapy before surgery or who lacked preoperative D-dimer data were excluded. The other 235 patients were divided into a high D-dimer (over 1.0 μg/mL) group (HDD group, n = 47) and a normal D-dimer group (NDD group, n = 188) and investigated for their clinical characteristics, computed tomography (CT) findings, pathological findings, and clinical outcomes. RESULTS The mean D-dimer levels was 2.49±2.58 μg/ml in the HDD group and 0.42±0.23 μg/ml in the NDD group. The HDD group was characterized by a predominance of male gender, older age, pure solid appearance on chest CT, vascular invasion in pathology, and a large solid part of the tumor. The HDD group showed a worse overall survival, disease-free survival, and disease-specific survival than the NDD group (p<0.001, <0.001, <0.001, respectively). These survival features were also observed in p-Stage IA disease. There was no marked survival difference when tumors showed ground-glass opacity on CT. CONCLUSION In NSCLC patients with a solid tumor appearance on CT, high D-dimer levels predict a poor survival and early recurrence.
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Affiliation(s)
- Yuki Shiina
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
- * E-mail:
| | - Takayoshi Yamamoto
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba Japan
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Razi SS, Nguyen D, Villamizar N. Lobectomy does not confer survival advantage over segmentectomy for non-small cell lung cancer with unsuspected nodal disease. J Thorac Cardiovasc Surg 2019; 159:2469-2483.e4. [PMID: 31928821 DOI: 10.1016/j.jtcvs.2019.10.165] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Conversion to lobectomy is typically performed when positive lymph nodes are found during intentional segmentectomy. Our objective was to evaluate survival after lobectomy and segmentectomy in patients with unsuspected nodal metastases. METHODS The National Cancer Database was queried for patients with clinical T1N0, pathological N1/N2 non-small cell lung cancer (NSCLC) who underwent either lobectomy or segmentectomy. Survival differences between the 2 groups were evaluated using a propensity score model. Cox regression analysis was used to evaluate predictors of overall survival, including adjuvant treatment. Statistical analysis was done using SPSS version 21.0 (IBM Corp, Armonk, NY). RESULTS Between 2004 and 2015, unsuspected pathological N1 disease for clinical T1N0M0 NSCLC was found in 2.5% (228/9118) and 6.7% (8915/132,604) of patients who underwent segmentectomy and lobectomy, respectively. The incidence of unsuspected pathological N2 disease for clinical T1N0M0 NSCLC was 2.4% (224/9118) after segmentectomy and 3.9% (5192/132,604) after lobectomy. Using propensity matched pairs (227 pairs for N1 and 215 for N2), segmentectomy showed equivalent 5-year survival compared with lobectomy for the N1 group (41.9% vs 44.3%; P = .35), and N2 group (41.6% vs 37.2%; P = .99). In a multivariable model, adjuvant chemotherapy was associated with better survival of patients with unsuspected N1 (hazard ratio, 0.613; 95% confidence interval, 0.536-0.700; P < .001) and N2 (hazard ratio, 0.684; 95% confidence interval, 0.583-0.802; P < .001) nodal metastases. CONCLUSIONS Survival is similar between lobectomy and segmentectomy for clinical T1N0 and unsuspected pathological N1/N2 nodal metastases. The use of adjuvant chemotherapy significantly improves survival in patients with lymph node metastasis (N1/N2) independent of the type of anatomic lung resection.
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Affiliation(s)
- Syed S Razi
- Section of Thoracic Surgery, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Fla
| | - Dao Nguyen
- Section of Thoracic Surgery, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Fla
| | - Nestor Villamizar
- Section of Thoracic Surgery, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Fla.
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New T1 classification. Gen Thorac Cardiovasc Surg 2019; 68:665-671. [PMID: 31679135 DOI: 10.1007/s11748-019-01233-0] [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: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
The IASLC staging and Prognostic Factor Committee proposed new changes to the descriptors for the 8th edition of the Tumour Node Metastasis Staging for Lung Cancer. The T1 descriptor changes include (1) T1 tumours are subclassified into T1a (< 1 cm), T1b (> 1 to < 2 cm), T1c (> 2 to < 3 cm). The corresponding changes are introduced to the overall staging: T1aN0M0 = Stage IA1; T1bN0M0 = Stage IA2; T1cN0M0 = Stage IA3. (2) The introduction of the pathological entities Adenocarcinoma-In-Situ (AIS), Minimally Invasive Adenocarcinoma, and Lepidic Predominant Adenocarcinoma. The corresponding changes on the T descriptor are as follows: Adenocarcinoma-in situ is coded as Tis (AIS); Minimally Invasive Adenocarcinoma is coded as T1a(mi). In this review, the basis for these changes will be described, and the implications on clinical practice will be discussed.
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Uniportal VATS for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:707-715. [PMID: 31617147 DOI: 10.1007/s11748-019-01221-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/13/2022]
Abstract
The video-assisted thoracic surgery (VATS) technique has evolved from its multiport origins to even less invasive approaches grounded in its proven benefits over open surgery for the treatment of early stage lung cancer. In this evolution process, the Uniportal VATS (UniVATS) strategy emerged. This technique is giving some evidence of benefits when compared to the multiport VATS and has been embraced by the surgical community spreading its geographical and surgical boundaries. Moreover, UniVATS has proven its feasibility for numerous and more complex procedures for lung cancer diagnosis and treatment, which are reviewed in this document as well as its current and future development.
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46
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Lim TY, Park S, Kang CH. A Meta-Analysis Comparing Lobectomy versus Segmentectomy in Stage I Non-Small Cell Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:195-204. [PMID: 31404409 PMCID: PMC6687045 DOI: 10.5090/kjtcs.2019.52.4.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
Abstract
Lobectomy is considered the standard strategy for early-stage non-small cell lung cancer (NSCLC). However, sublobar resection for NSCLC has recently received increased attention. The objective of this study was to compare 5-year survival, recurrence-free survival, postoperative mortality, and postoperative morbidities in patients who received segmentectomy versus those who received lobectomy through a meta-analysis. Sixteen studies were included and the combined hazard ratios or odds ratios were calculated. The results revealed that the 5-year survival rate after segmentectomy was comparable to that of lobectomy for stage IA NSCLC. However, segmentectomy for stage I NSCLC had lower rates of postoperative mortality and morbidities than lobectomy.
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Affiliation(s)
- Tae Yoon Lim
- Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Fiorelli A, Mauro I, Cicchitto G, Prencipe A, Polverino M, Di Crescenzo VG, Santini M. Lobar or sublobar resections are safe procedures for management of early lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S107. [PMID: 31576314 DOI: 10.21037/atm.2019.05.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Aldo Prencipe
- Cardio-Thoracic Surgery, Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Mario Santini
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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Lopez-Pastorini A, Stoelben E, Koryllos A. Editorial on "Trans-inferior-pulmonary-ligament VATS basal segmentectomy: application of single-direction strategy in segmentectomy of left S9+10". J Thorac Dis 2019; 11:S283-S285. [PMID: 30997198 DOI: 10.21037/jtd.2019.01.59] [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)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
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49
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Razi SS, Nguyen D, Villamizar N. Minimally invasive segmentectomy for early stage lung cancer gains momentum. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:62. [PMID: 30906766 DOI: 10.21037/atm.2018.12.67] [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)
- Syed S Razi
- Division of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Dao Nguyen
- Division of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nestor Villamizar
- Division of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
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50
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Thai A, Stuart E, te Marvelde L, Milne R, Knight S, Whitfield K, Mitchell P. Hospital lung surgery volume and patient outcomes. Lung Cancer 2019; 129:22-27. [DOI: 10.1016/j.lungcan.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
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