1
|
Harada H, Suefuji H, Mori K, Ishikawa H, Nakamura M, Tokumaru S, Murakami M, Ogino T, Iwata H, Tatebe H, Kubo N, Waki T, Yoshida D, Nakamura M, Hashimoto T, Araya M, Nakajima M, Nakayama H, Satouchi M, Shioyama Y. Proton and carbon ion radiotherapy for operable early-stage lung cancer; a prospective nationwide registry. Radiother Oncol 2024; 198:110385. [PMID: 38901770 DOI: 10.1016/j.radonc.2024.110385] [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: 03/14/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND PURPOSE To investigate the toxicity and survival outcomes of proton and carbon ion radiotherapy for patients with operable early-stage lung cancer who are eligible for lobectomy. MATERIALS AND METHODS This multicenter nationwide prospective cohort study included patients with operable early-stage lung cancer. Proton and carbon ion radiotherapy was performed according to the schedule stipulated in the unified treatment policy. Progression-free survival (PFS), overall survival (OS) and treatment-related toxicities were evaluated. RESULTS A total of 274 patients were enrolled and included in efficacy and safety analyses. The most common tumor type was adenocarcinoma (44 %), while 105 cases (38 %) were not histologically confirmed or diagnosed clinically. Overall, 250 (91 %) of the 274 patients had tumors that were peripherally situated, while 138 (50 %) and 136 (50 %) patients were treated by proton and carbon ion radiotherapy, respectively. The median follow-up time for all censored patients was 42.8 months (IQR 36.7-49.0). Grade 3 or severe treatment-related toxicity was observed in 4 cases (1.5 %). Three-year PFS was 80.5 % (95 % CI: 75.7 %-85.5 %) and OS was 92.5 % (95 % CI: 89.3 %-95.8 %). Pathological confirmation and clinical stage were factors significantly associated with PFS, while tumor location and particle-ion type were not. Meanwhile, clinical stage was significantly associated with OS, but pathological confirmation, tumor location, and particle-ion type were not. CONCLUSIONS Particle therapy for operable early-stage lung cancer resulted in excellent 3-year OS and PFS in each subset. In this disease context, proton and carbon ion beam therapies are feasible alternatives to curative surgery.
Collapse
Affiliation(s)
- Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan.
| | - Hiroaki Suefuji
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Saga, Japan.
| | - Keita Mori
- Department of Biostatistics, Clinical Research Support Center, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan.
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Chiba, Japan.
| | - Masaki Nakamura
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Takashi Ogino
- Medipolis Proton Therapy and Research Center, Ibusuki, Kagoshima, Japan.
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Aichi, Japan.
| | - Hitoshi Tatebe
- Fukui Prefectural Hospital Proton Therapy Center, Fukui, Fukui, Japan.
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takahiro Waki
- Department of Radiology, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | | | - Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Takayuki Hashimoto
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
| | - Masayuki Araya
- Proton Therapy Center, Aizawa Hospital, Matsumoto, Nagano, Japan.
| | - Mio Nakajima
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Chiba, Japan.
| | - Haruhiko Nakayama
- Kanagawa Preventive Medicine Association, Yokohama, Kanagawa, Japan.
| | | | | |
Collapse
|
2
|
Huang L, Petersen RH. Impact of number of dissected lymph nodes on recurrence and survival following thoracoscopic segmentectomy for clinical stage I non-small cell lung cancer. Lung Cancer 2024; 193:107846. [PMID: 38838518 DOI: 10.1016/j.lungcan.2024.107846] [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: 02/05/2024] [Revised: 04/12/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE This study aimed to identify the impact of number of dissected lymph nodes during thoracoscopic segmentectomy on recurrence and survival of clinical stage I non-small cell lung cancer (NSCLC). PATIENTS AND METHODS We retrospectively analysed data from prospectively collected consecutive thoracoscopic segmentectomies conducted between June 2008 and September 2023 at a single institution. Kaplan-Meier analysis with log-rank test assessed OS. Fine-Gray's test assessed specific death in a competing risk model. The logistic regression model was utilized to predict recurrence, while the Cox regression model was employed to analyse overall survival (OS). Subgroup and sensitivity analyses were performed. RESULTS A total of 227 patients were included in the final analyses. The mean follow-up was 38.4 months (standard deviation 35.8). Among all patients, 37 patients (16.3 %) experienced recurrence and 51 (22.5 %) deceased during the follow-up period. The median number of dissected lymph nodes was 9 (interquartile range (IQR) 6-12). No statistical difference in recurrence rate and 5-year OS was observed between cases with dissected lymph nodes > 9 and ≤ 9 (14.6 % vs. 17.6 %, p = 0.549; 75.5 % vs. 69.5 %, p = 0.760). On multivariable analysis, body mass index (odds ratio [OR] 1.15, p = 0.002), Charlson Comorbidity index (OR 1.28, p = 0.002), synchronous pulmonary cancer (OR 3.05, p = 0.019), and tumour size (OR 1.04, p = 0.044) increased of the recurrence rate, while percentage of predicted forced expiratory volume in 1 s (hazard ratio (HR) 1.09, p = 0.048), history of smoking (HR 1.02, p = 0.009), and solid nodule (HR 1.56, p = 0.010) was related to poorer survival. CONCLUSIONS In this study, number of dissected lymph nodes did not impact recurrence rate or overall survival after thoracoscopic segmentectomy for clinical stage I NSCLC.
Collapse
Affiliation(s)
- Lin Huang
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. https://twitter.com/@RicardoHuang7
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
3
|
Gioutsos K, Galanis M, Dorn P. Is "less actually enough" when it comes to left upper division tumors? J Thorac Dis 2023; 15:3509-3512. [PMID: 37559631 PMCID: PMC10407528 DOI: 10.21037/jtd-23-575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Michail Galanis
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Brunelli A, Decaluwe H, Gonzalez M, Gossot D, Petersen RH, Augustin F, Assouad J, Baste JM, Batirel H, Falcoz PE, Almanzar SF, Furak J, Gomez-Hernandez MT, de Antonio DG, Hansen H, Jimenez M, Koryllos A, Meacci E, Opitz I, Pages PB, Piwkowski C, Ruffini E, Schneiter D, Stupnik T, Szanto Z, Thomas P, Toker A, Tosi D, Veronesi G. European Society of Thoracic Surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer. Eur J Cardiothorac Surg 2023; 63:ezad224. [PMID: 37267148 DOI: 10.1093/ejcts/ezad224] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Michel Gonzalez
- Department of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Dominique Gossot
- Department of Thoracic Surgery, IMM-Curie-Montsouris Thoracic Institute, Paris, France
| | - Rene Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Jalal Assouad
- Department of Thoracic Surgery. Tenon Hospital, Sorbonne University-Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean Marc Baste
- Department of Cardio-Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Hasan Batirel
- Department of Thoracic Surgery, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | | | | | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - David Gomez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Henrik Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marcelo Jimenez
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Aris Koryllos
- Department of Thoracic Surgery, Florence Nightingale Hospital, Duesseldorf, Germany
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Catholic University of Sacred Hearth, Rome, Italy
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Cezary Piwkowski
- Thoracic Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Enrico Ruffini
- Division of Thoracic Surgery, University of Torino, Turin, Italy
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tomaz Stupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Zalan Szanto
- Department of Thoracic Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Pascal Thomas
- Department of Thoracic Surgery, North Hospital, APHM/Aix-Marseille University, Marseille, France
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Veronesi
- Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
5
|
Salvicchi A, Tombelli S, Mugnaini G, Gonfiotti A. Lung Segmentectomy in NSCLC Surgery. Life (Basel) 2023; 13:1284. [PMID: 37374067 DOI: 10.3390/life13061284] [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: 05/18/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Current guidelines recommend surgery for early-stage non-small cell lung cancer (NSCLC). The standard treatment for patients with cT1N0 NSCLC has been lobectomy with lymph-node dissection, with sublobar resection used only in patients with inadequate cardio-respiratory reserve, with poor performance status, or who are elderly. In 1995, the Lung Cancer Study Group published the results of a randomized, prospective trial demonstrating the superiority of lobectomy compared with sublobar resection. From then on, wedge resection and segmentectomy were reserved exclusively for patients with poor functional reserve who could not tolerate lobectomy. Therefore, the exact role of segmentectomy has been controversial over the past 20 years. Recently, the randomized controlled trial JCOG0802/WJOG4607L demonstrated that segmentectomy was superior to lobectomy in patients with stage IA NSCLC (<2 cm and CTR < 0.5) in terms of both overall-survival and post-operative lung function. Based on these results, segmentectomy should be considered the standard surgical procedure for this patient group. In 2023, the randomized phase III CALGB 140503 (Alliance) trial demonstrated the efficacy and non-inferiority of sublobar resection, including wedge resection, for clinical stage IA NSCLC with tumor diameter of < 2 cm. This article is a narrative review of the current role of segmentectomy in lung cancer treatment and summarizes the most relevant studies in this context.
Collapse
Affiliation(s)
- Alberto Salvicchi
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Simone Tombelli
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Giovanni Mugnaini
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandro Gonfiotti
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| |
Collapse
|
6
|
Gossot D. Lobar or sublobar resection for early-stage lung cancer: at the crossroads. Eur J Cardiothorac Surg 2021; 60:1295-1296. [PMID: 34549303 DOI: 10.1093/ejcts/ezab363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thoracic Institute-Institut Mutualiste Montsouris, Paris, France
| |
Collapse
|
7
|
Gossot D, Mariolo AV, Lefevre M, Boddaert G, Brian E, Grigoroiu M, Girard N, Seguin-Givelet A. Strategies of Lymph Node Dissection During Sublobar Resection for Early-Stage Lung Cancer. Front Surg 2021; 8:725005. [PMID: 34631783 PMCID: PMC8495255 DOI: 10.3389/fsurg.2021.725005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/23/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Alessio Vincenzo Mariolo
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Marine Lefevre
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - Guillaume Boddaert
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Madalina Grigoroiu
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Girard
- Department of Oncology, Curie-Montsouris Thorax Institute-Institut Curie, Paris, France.,Faculty of Medicine Simone Veil, Paris Saclay University, UVSQ, Versailles, France
| | - Agathe Seguin-Givelet
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris, Paris, France.,Faculty of Medicine SMBH, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| |
Collapse
|
8
|
Gossot D, Mariolo AV, Grigoroiu M, Bardet J, Boddaert G, Brian E, Seguin-Givelet A. Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures. J Thorac Dis 2021; 13:4378-4387. [PMID: 34422364 PMCID: PMC8339731 DOI: 10.21037/jtd-20-3521] [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: 12/15/2020] [Accepted: 04/09/2021] [Indexed: 12/01/2022]
Abstract
Background Thoracoscopic complex basilar segmentectomies are technically demanding and challenging. We review our experience to check whether this complexity can lead to specific surgical issues or increased post-operative morbidity. Methods Complex basilar segmentectomies were defined as the anatomical resection of at least one segment composing the basilar pyramid, excluding S6. Data of patients who had an intention-to-treat thoracoscopic complex basilar segmentectomy were retrospectively collected from 2007 to 2019: indications, preoperative assessment, clinical features, operative technical aspects and early post-operative outcome. Results Sixty-three patients, 26 men (41%) and 37 women (59%) with a median age of 66 years and a median body mass index (BMI) of 26 kg/m2 were included. Interventions performed were mostly S9+10 (n=32) and S8 (n=12) segmentectomies. Forty-five planned operations (71%) were completed. Extension to a larger resection was necessary in 17 patients (27%) and 4 patients underwent conversion to open surgery (6%). Median operative time was 168 minutes with a median intraoperative bleeding of 30 mL. Complications occurred in 11 patients (17%). There was no mortality. Median length of pleural drainage was 2 days (range, 1–2 days) and median hospital stay 4 days. Conclusions The extension rate of complex basilar segmentectomy is higher than that of other sublobar resections but their post-operative morbidity is identical.
Collapse
Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Alessio Vincenzo Mariolo
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Madalina Grigoroiu
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Jérémy Bardet
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Guillaume Boddaert
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Emmanuel Brian
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| |
Collapse
|
9
|
Meacci E, Nachira D, Zanfrini E, Triumbari EKA, Iaffaldano AG, Congedo MT, Petracca Ciavarella L, Pogliani L, Chiappetta M, Porziella V, Gonzalez-Rivas D, Vita ML, Margaritora S. Uniportal VATS approach to sub-lobar anatomic resections: literature review and personal experience. J Thorac Dis 2020; 12:3376-3389. [PMID: 32642263 PMCID: PMC7330759 DOI: 10.21037/jtd.2020.01.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Surgical scientific literature contains relatively little information regarding the surgical outcomes of anatomic sublobar resections performed with the uniportal video-assisted thoracoscopic surgery (U-VATS) technique. This paper attempts to evaluate the role of U-VATS segmentectomies in the landscape of a minimally invasive approach to the treatment of early stage non small cell lung cancer (NSCLC).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China
| | | | | |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Bilgi Z, Swanson SJ. Current indications and outcomes for thoracoscopic segmentectomy for early stage lung cancer. J Thorac Dis 2019; 11:S1662-S1669. [PMID: 31516739 DOI: 10.21037/jtd.2019.07.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Management of early stage non-small cell lung cancer (NSCLC) is evolving as the epidemiology of NSCLC has changed due to decreased rates of smoking in the general population, the development of screening programs and advancements in imaging modalities. Surgical technique is also evolving as a result of changes in instrumentation. Segmentectomy for early stage NSCLC has the advantage of preservation of lung function. Video-assisted thoracic surgery (VATS) segmentectomy is a safe option for surgeons already experienced in VATS lobectomy and offers comparable oncological benefit with better quality of life in selected patients. In this article, we will examine the role of segmentectomy and VATS for early stage NSCLC.
Collapse
Affiliation(s)
- Zeynep Bilgi
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott J Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|