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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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Yu G, Jiang X, Cao H, Huang B. Bilateral synchronous multiple lung nodules: Surgical experience from two cases. Saudi J Biol Sci 2018; 25:971-974. [PMID: 30108449 PMCID: PMC6088106 DOI: 10.1016/j.sjbs.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 11/29/2022] Open
Abstract
Synchronous multiple lung cancer (SMPLC) has been increasingly detected as a result of improved imaging techniques, though the incidence of SMPLC is rare. Surgery is currently the only treatment offering potential cure and long-term survival in patients with SMPLC, and complete resection is widely accepted as the first choice of procedure for this type. However, due to the rarity of this clinical scenario, many surgeons lack experience in surgical treatment of SMPLC. Here, we present two cases whose SMPLC was successfully managed with aggressive surgical therapy through video-assisted thoracoscopic surgery.
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Affiliation(s)
- Guiping Yu
- Department of Cardiothoracic Surgery, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Xia Jiang
- Department of Cardiothoracic Surgery, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Hongbao Cao
- Department of Biology Products, Life Science Solutions, Elsevier, Inc., Rockville, USA
| | - Bin Huang
- Department of Cardiothoracic Surgery, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
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Sawabata N, Kawase A, Takahashi N, Kawaguchi T, Woo T, Saito Y, Shiono S, Matsutani N. Validating margin status in lung wedge resection for clinical stage I non-small cell lung cancer. Surg Today 2018; 48:963-967. [PMID: 29922942 DOI: 10.1007/s00595-018-1683-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/27/2018] [Indexed: 12/25/2022]
Abstract
Stage I non-small cell lung cancer (NSCLC) is a localized disease without metastasis; therefore, it can be treated effectively with local therapies. Pulmonary resection is the most frequent treatment, performed as pulmonary wedge resection, segmentectomy, lobectomy, or pneumonectomy. Some retrospective clinical studies of pulmonary wedge resection suggest that its outcome may be inferior to that of anatomical pulmonary resection, whereas other recent studies, which assess surgical margin status, leveled acceptable outcomes. Since the outcome of pulmonary wedge resection for lung cancer may depend on tumor size, distance from the surgical margin to the tumor, tumor size/margin distance ratio, and margin cytology results, a prospective study assessing these parameters is ongoing. This will allow us to identify the clinical implications of these factors and predict which patients are likely to have a good outcome.
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Affiliation(s)
- Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara Medical University Hospital, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan. .,General Thoracic Surgery, Hoshigaoka Medical Center, Hirakata, Japan.
| | - Akikazu Kawase
- First Department of Surgery, Hamamatsu Medical University School of Medicine, Hamamatzu, Japan
| | - Nobumasa Takahashi
- Department of Respiratory Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara Medical University Hospital, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 634-8522, Japan
| | - Tetsukan Woo
- Department of Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Yuichi Saito
- Department of Respiratory Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan
| | - Satoshi Shiono
- Department Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
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Mediratta N, Poullis M. Smoking status and 30-day mortality in patients undergoing pulmonary resections. Asian Cardiovasc Thorac Ann 2016; 24:663-9. [PMID: 27365496 DOI: 10.1177/0218492316657252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Smoking status has not been shown to have a significant effect on 30-day mortality after potentially curative resectional surgery for non-small-cell lung cancer, and this is reflected in the guidelines of the National Institute for Health and Care Excellence in the United Kingdom. METHODS A validated prospective thoracic surgery database of consecutive patients undergoing potentially curative resection at a single institution was analyzed. Univariate and propensity analyses of 30-day mortality were performed. RESULTS Univariate analysis identified 30-day mortality as significantly lower in current smokers (n = 852, 2.6%) than ex-smokers (n = 1587, 4.9%; p < 0.001). Propensity 1:1 matching of male patients resulted in 727 current smokers being matched to 727 ex-smokers. The overall balance test (χ(2 )= 6.1, degrees of freedom = 8, p = 0.6), indicated a good match. After propensity matching, the mortality rate was significantly higher in current smokers (p = 0.01). CONCLUSIONS Current smokers and ex-smokers are statistically different with regard to risk factors for death. This results in a skewed population of current and ex-smokers undergoing resection for non-small-cell lung cancer. Development of a risk model for 30-day mortality revealed that current smokers have a lower predicted 30-day mortality than ex-smokers, a finding that is counterintuitive. Propensity matching balanced the current and ex-smoker groups to correct for group differences. Analysis after propensity matching identified current smoking as a significant factor determining 30-day mortality.
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Pricopi C, Rivera C, Abdennadher M, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Place of limited resections and prognostic factors in non-small lung cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:207-216. [PMID: 25794877 DOI: 10.1016/j.pneumo.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/15/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Results of surgery for non-small-cell lung cancer (NSCLC) are poorer after limited resection, wedge and segmentectomy, than after lobectomy. Guidelines recommend avoiding wedge-resection, which new techniques (radiofrequency ablation and cyberknife) tend to replace. This work aimed to study the wedge-resection carcinological value. PATIENTS AND METHODS NSCLC without previous other cancer history and neoadjuvant therapy measuring less than 31 millimetres and operated from 1980 to 2009 were reviewed. Analyzed variables were: location, gender, age, FEVS, type of resection, histology, pT and pN. RESULTS There were 66 wedge-resections (10.9%), 32 segmentectomies (5.3%), 507 lobectomies (83.8%), nine postoperative deaths (1.5%), 136 complications (22.5%), 557 complete resections (R0=92%); 72.2% of NSCLC upper lobe location (437/605). Age was more advanced in wedge-resection and segmentectomy, FEVS lower and NSCLC most often a squamous cell pN0 and pStage I carcinoma than in lobectomy. Lymphadenectomy was not performed in half the wedge-resections. Five-year survival rates were poorer after wedge-resection: 50% versus segmentectomy 59.8% (P=0.09), and lobectomy 66% (P=0.0035), but the number of recurrences was similar. Multivariate analysis demonstrated that age, FEVS, type of surgery and lymphadenectomy, pN in pTNM were the only prognosis factors. CONCLUSION Wedge-resection is less carcinological than segmentectomy when the patient-status and NSCLC location allow performing the latter, but more than the new techniques, because of its pathological yield, when the patient-status and nodule peripheral location allow wedging.
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Affiliation(s)
- C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Abdennadher
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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刘 博, 丁 凤, 杨 双. [Progress of Postoperative Adjuvant Chemotherapy in Stage I Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:374-80. [PMID: 26104895 PMCID: PMC5999912 DOI: 10.3779/j.issn.1009-3419.2015.06.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/28/2015] [Indexed: 11/05/2022]
Abstract
The morbidity and mortality of lung cancer rank the first place among all the malignant tumor. According to the histopathological characteristics, lung cancer is divided into non-small cell lung cancer (NSCLC) and small cell lung cancer. Only 20% patients diagnosed with NSCLC have the chance for surgery while their 5-yr overall survival is about 30%-60%. The therapeutic outcome of surgery alone is not satisfying. Adjuvant chemotherapy after surgical resection in stage II-IIIa lung cancer showed efficacy in many randomized clinical trials, but its role in stage I disease remains controversial. The choice of appropriate chemotherapy candidates, the selection of chemotherapy regimens and the research progress on biomarker are mainly discussed in this review.
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Affiliation(s)
- 博 刘
- />400016 重庆,重庆医科大学附属第一医院胸心外科Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 凤霞 丁
- />400016 重庆,重庆医科大学附属第一医院胸心外科Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - 双强 杨
- />400016 重庆,重庆医科大学附属第一医院胸心外科Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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