Abstract
ObjectivesThe choice of resection method for geriatric patients with early-stage non-small cell lung cancer (NSCLC) remains contentious. This study aimed to evaluate survival and perioperative outcomes after thoracoscopic lobectomy resection (LR) or sublobar resection (SR) in patients aged ≥75 years with pathologic stage (pStage) I NSCLC.Materials and MethodsWe retrospectively examined 258 consecutive patients aged ≥75 years with pStage I NSCLC who underwent thoracoscopic tumor resection at our institute from 2011 to 2018. Propensity score matching (PSM) analysis identified 60 patients in each group for comparison of survival-related parameters, including disease-free survival (DFS), lung cancer-specific overall survival (OS), and non-lung cancer-specific OS, using the Kaplan-Meier analysis.ResultsLR and SR were performed in 84 (32.6%) and 174 (67.4%) patients aged ≥75 years, respectively. The LR group had younger patients, better performance status, larger tumor sizes, and deeper tumor location than the SR group. Multivariate studies showed that the resection method was not a prognostic factor for OS. The two PSM-matched groups were not significantly different with respect to lung cancer-specific OS (p = 0.116), non-lung cancer-specific OS (p = 0.408), and DFS (p = 0.597). SR helped achieve better perioperative outcomes than LR, including fewer postoperative complications (10.0% vs. 28.3%, p = 0.011), shorter operative times (p < 0.001), decreased blood loss (p = 0.026), and shorter chest tube duration (p = 0.010) and hospital stays (p = 0.035).ConclusionsThoracoscopic SR may provide similar oncological outcomes to LR, but may be a safer and more feasible surgical method for geriatric patients with pStage I NSCLC.
Highlights
Lung cancer is the leading cause of cancer death [1]
This study aimed to evaluate survival and perioperative outcomes after thoracoscopic lobectomy resection (LR) or sublobar resection (SR) in patients aged ≥75 years with pathologic stage I non-small cell lung cancer (NSCLC)
SR helped achieve better perioperative outcomes than Lobectomy resection (LR), including fewer postoperative complications (10.0% vs. 28.3%, p = 0.011), shorter operative times (p < 0.001), decreased blood loss (p = 0.026), and shorter chest tube duration (p = 0.010) and hospital stays (p = 0.035)
Summary
Lung cancer is the leading cause of cancer death [1]. The median age at diagnosis of non-small cell lung cancer (NSCLC) is 71 years in the Western world, with 36.3% of cases occurring among individuals aged ≥75 years [1]. The detection rate of early-stage cancers in the elderly population is expected to substantially increase with the widespread use of computed tomography (CT) screening [2, 3]. The management of early NSCLC in older patients presents a major challenge. Lobectomy resection (LR) is the standard curative treatment for early-stage NSCLC [4, 5]. SR represents a feasible surgical method for geriatric patients with early NSCLCs [8,9,10,11,12,13,14]. Despite the high incidence of lung cancer in the elderly population, the preferred resection method (i.e., LR or SR) in patients with early-stage NSCLC is still controversial [4]. No previous study has compared thoracoscopic LR with SR in geriatric patients with early NSCLCs
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