Abstract
BackgroundAs segmentectomy had become commonly used for Non-Small Cell Lung Cancer (NSCLC) treatment, which had the advantages of radical operation, however, it remains controversial owing to procedural complexity and risk of increased complications compared with wedge resection. We evaluated operative and postoperative outcomes of simple segmentectomy compared to wedge resection in ground-glass opacity (GGO) diameter between 2 cm and 3 cm NSCLC.MethodsWe retrospectively reviewed 1600 clinical GGO diameter between 2 cm and 3 cm NSCLC patients who received simple segmentectomy and wedge resection between Jan 2011 and Jan 2015. Participants were matched 1:1 on their propensity score for two groups. Clinic-pathologic, operative, and postoperative results of two groups were compared.ResultsAfter using propensity score methods to create a matched cohort of participants with simple segmentectomy group similar to that wedge resection, there were no significant differences detected in tumor size, margin distance, histology, age, sex, preoperative comorbidities and preoperative pulmonary function. Overall complications in simple segmentectomy group were more than wedge resection group (21% vs 3%, p = 0.03). Median operative time (110.6 vs. 71.2 min; p = 0.01) and prolonged air leakage (12% vs. 3%; p = 0.02) was significantly longer in the simple segmentectomy group. There was no difference in recurrence free survival (RFS) and overall survival (OS) of 5-years between simple segmentectomy group and wedge resection group. Postoperative pulmonary function in simple segmentectomy group recovered more slowly than wedge resection group.ConclusionWedge resection may have comparable efficacy as simple segmentectomy for GGO diameter between 2 cm and 3 cm NSCLC, but lead to less complications, less surgical procedure and faster recovery of pulmonary function.
Highlights
As segmentectomy had become commonly used for Non-Small Cell Lung Cancer (NSCLC) treatment, which had the advantages of radical operation, it remains controversial owing to procedural complexity and risk of increased complications compared with wedge resection
Over the last few decades, pulmonary lobectomy with systemic meditational lymphadenectomy has been chosen as the standard surgical therapy for NSCLC, which found that sublobar resection was associated with inferior overall survival and high recurrence chance compared to pulmonary lobectomy [1]
There were 510 patients left for propensity score matching (Supplementary table), which resulted in simple segmentectomy group (n = 100) versus the wedge resection group (n = 100) forming 1:1 matching (Fig. 1, Table 1)
Summary
As segmentectomy had become commonly used for Non-Small Cell Lung Cancer (NSCLC) treatment, which had the advantages of radical operation, it remains controversial owing to procedural complexity and risk of increased complications compared with wedge resection. We evaluated operative and postoperative outcomes of simple segmentectomy compared to wedge resection in ground-glass opacity (GGO) diameter between 2 cm and 3 cm NSCLC. Many researches have reported that sublobar resection for small size tumors of stage I NSCLC can yield similar outcomes to those patients undergoing lobectomy [3, 4]. Pulmonary segmentectomy probably could become the standard treatment choice for NSCLC with early stage recently, which is selected more frequently [5]. Wedge resection, still as one of sublobar resection type, has been criticized for its marginal recurrence and short of thoroughness without lymph node dissection, which affects its clinical value [4]
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