Prospective angiographic data in asymptomatic patients with all three internal mammary, radial artery and saphenous vein grafts more than 10 years postoperative

Abstract

Introduction: The standard surgical treatment of resectable early-stage non-small cell lung cancer (NSCLC) involves a lobectomy or greater resection through a conventional thoracotomy or thoracoscopic approach. However, changes to radiological screening programs, patient selection strategies and a greater understanding of histological prognostic factors have heightened the interest in sublobar resection in recent years. Patients who undergo segmentectomies or wedge resections may benefit from less morbidity and greater lung volume preservation. The aim of the present systematic review and meta-analysis was to compare lobectomy versus segmentectomy and wedge resection procedures in the ‘intentionally selected’ and ‘compromised’ patient cohorts. Methods: A systematic review was performed using 6 online databases from their dates of inception to December 2013. The primary outcomes for themeta-analysis was overall survival. Data were extracted from article texts, tables, and figures. Two investigators independently reviewed each retrieved article and discrepancies were resolved by discussion and consensus.Meta-analysiswas performed by combining the reported overall survival outcomes of individual studies. Hazard ratio (HR) and standard error were extracted or calculated from each study. Results: Twenty-five studies identified relevant data on overall survival for segmentectomy versus lobectomy, including 8 studies that demonstrated superior overall survival after lobectomy (p = 0.05) in the ‘compromised’ cohort and 5 studies that demonstrated no significant difference after either procedure (p = 0.62) in the ‘intentional’ cohort. Similarly, 8 studies found superior survival after lobectomy compared to sublobar resections in the ‘compromised’ group but no significant difference when the ‘intentional’ cohort was compared (p = 0.48). In regards to disease-free survival, there was a strong trend favouring lobectomy compared to segmentectomy (p = 0.06) in the ‘compromised’ group but no significant difference in the ‘intentional’ cohort (p = 0.46). Discussion: The present meta-analysis is the first to compare sublobar resections versus lobectomy procedures with a focus on the patient selection process. Our findings suggest that patients who undergo sublobar resections have worse overall survival outcomes in ‘compromised’ patients who were not eligible for a lobectomy procedure. However, for those ‘intentionally’ selected patients who underwent a sublobar resection but could have tolerated a lobectomy procedure, their overall and disease-free survival were similar to the lobectomy group. The selection process of these ‘intentional’ patients have been examined in detail, and two randomised-controlled trials currently underway were discussed.