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Galanis M, Leivaditis V, Gioutsos K, Panagiotopoulos I, Kyratzopoulos A, Mulita F, Papaporfyriou A, Verras GI, Tasios K, Antzoulas A, Skevis K, Kontou T, Koletsis E, Ehle B, Dahm M, Grapatsas K. Segmentectomy versus lobectomy. Which factors are decisive for an optimal oncological outcome? KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2023; 20:179-186. [PMID: 37937171 PMCID: PMC10626409 DOI: 10.5114/kitp.2023.131943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/25/2023] [Indexed: 11/09/2023]
Abstract
Low-dose computed tomography is being used for lung cancer screening in high-risk groups. Detecting lung cancer at an early stage improves the chance of optimal treatment and increases overall survival. This article compares segmentectomy vs. lobectomy as surgical options, in the case of stage I non-small cell lung carcinoma, ideally IA. To compare the 2 previously referred strategies, data were collected from articles (40 studies were reviewed), reviews, and systematic analyses in PubMed Central, as well as reviewing recent literature. Segmentectomy could be an equal alternative to lobectomy in early-stage NSCLC (tumour < 2 cm). It could be preferred for patients with a low cardiopulmonary reserve, who struggle to survive a lobectomy. As far as early-stage NSCLC is concerned, anatomic segmentectomy is an acceptable procedure in a selective group of patients. For better tumour and stage classification, a systematic lymph node dissection should be performed.
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Affiliation(s)
- Michail Galanis
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Anastasia Papaporfyriou
- Department of Pulmonology, Internal Medicine II, Vienna University Hospital, Vienna, Austria
| | | | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Theoni Kontou
- Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, Greece
| | - Benjamin Ehle
- Department of Thoracic Surgery, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Liu L, Aokage K, Chen C, Chen C, Chen L, Kim YH, Lee CY, Liu C, Liu CC, Nishio W, Suzuki K, Tan L, Tseng YL, Yotsukura M, Watanabe SI. Asia expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study. JTCVS OPEN 2023; 14:483-501. [PMID: 37425437 PMCID: PMC10328970 DOI: 10.1016/j.xjon.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 07/11/2023]
Abstract
Objective Segmentectomy as a parenchymal-sparing surgical approach has been recommended over lobectomy in select patients with early-stage non-small cell lung cancer. This study aimed to address 3 aspects of segmentectomy ("patient indication"; "segmentectomy approaches"; "lymph node assessment") where there is limited clinical guidance. Methods A modified Delphi approach comprising 3 anonymous surveys and 2 expert discussions was used to establish consensus on the aforementioned topics among 15 thoracic surgeons (2 Steering Committee; 2 Task Force; 11 Voting Experts) from Asia who have extensive segmentectomy experience. Statements were developed by the Steering Committee and Task Force based on their clinical experience, published literature (rounds 1-3), and comments received from Voting Experts through surveys (rounds 2-3). Voting Experts indicated their agreement with each statement on a 5-point Likert scale. Consensus was defined as ≥70% of Voting Experts selecting either "Agree"/"Strongly Agree" or "Disagree"/"Strongly Disagree." Results Consensus from the 11 Voting Experts was reached on 36 statements (11 "patient indication" statements; 19 "segmentation approaches" statements; 6 "lymph node assessment" statements). In rounds 1, 2, and 3, consensus was reached on 48%, 81%, and 100% of drafted statements, respectively. Conclusions A recent phase 3 trial reported significantly improved 5-year overall survival rates for segmentectomy compared with lobectomy, proposing thoracic surgeons to consider segmentectomy as a surgical option in suitable patients. This consensus serves as a guidance to thoracic surgeons considering segmentectomy in patients with early non-small cell lung cancer, outlining key principles that surgeons should consider in surgical decision-making.
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Affiliation(s)
- Lunxu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Centre Hospital East, Chiba, Japan
| | - Chang Chen
- Division of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yong-Hee Kim
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, KOO Foundation Cancer Centre, Taipei, Taiwan
| | - Wataru Nishio
- Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan
| | - Lijie Tan
- Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Centre Central Hospital, Tokyo, Japan
| | - Shun-ichi Watanabe
- Department of Thoracic Surgery, National Cancer Centre Central Hospital, Tokyo, Japan
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He Z, Li Z, Xu S, Wu W, Zhu Q, Wang J, Wen W, Chen L. Prognostic Significance of Lymph Node Count Removed at Sublobar Resection in Pathologic Stage IA Non-Small-cell Lung Cancer: A Population-Based Analysis. Clin Lung Cancer 2020; 22:e563-e573. [PMID: 33214078 DOI: 10.1016/j.cllc.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND We sought to elucidate the associations between the examined lymph node (ELN) count and survival after sublobar resection (SLR) in pathologic stage IA non-small-cell lung cancer and assess the survival efficacy for patients undergoing SLR with an adequate ELN count compared with lobar resection (LR). PATIENTS AND METHODS The newly released U.S. Surveillance, Epidemiology, and End Results database was queried. The association between the ELN count in SLR and survival was analyzed using Cox regression and propensity score matching analyses. The optimal cutoff for the ELN count in SLR was determined using the Chow test and "segmented" function. Survival differences between SLR with an adequate ELN count and LR were compared using the log-rank test. RESULTS A total of 16,630 lobectomies, 3979 wedge resections, and 1119 segmentectomies were included in the present study. The median ELN count was 3 (interquartile range [IQR], 1-7), 1 (IQR, 0-4), and 7 (IQR, 4-12) for segmentectomy, wedge resection, and lobectomy, respectively (P < .001). The optimal cutoff for ELNs was 2.40 (IQR, 2.15-2.65) and 2.59 (IQR, 2.19-3.00) for patients undergoing wedge and segmental resection. SLR patients with ≥ 3 ELNs showed better overall survival and lung cancer-specific survival compared with those with < 3 ELNs. SLR patients with ≥ 3 ELNs had a noninferior prognosis compared with LR patients after matching of potential confounders. CONCLUSIONS In SLR, an adequate ELN count (≥ 3) could confer an improved prognosis compared with an inadequate ELN count (< 3). SLR patients with an adequate ELN count had noninferior survival outcomes compared with LR patients when the ELNs were well matched.
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Affiliation(s)
- Zhicheng He
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhihua Li
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Song Xu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Weibing Wu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Wen
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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