Segmentectomy For Stage Research Articles

Comparative analysis of the clinical effects of different thoracoscopic resection in the treatment of Stage I Non-Small Cell Lung Cancer.

To compare and analyze the clinical effects of thoracoscopic lobectomy and segmentectomy in stage I non-small cell lung cancer (NSCLC). This was a retrospective study. Eighty patients with stage I NSCLC treated in Cangzhou People's Hospital from December 2019 to January 2022 were randomly divided into the segmentectomy group and lobectomy group, with 40 cases in each group. Further comparative analysis was carried out focusing on perioperative indexes, maximum ventilation volume (MVV), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), VAS score of postoperative pain and complications. There was no significant difference in the number of dissected lymph nodes and extubation time between the two groups (p>0.05). The operation time was longer, while intraoperative blood loss was less and the stay of stay in hospital was shorter in the segmentectomy group significantly than those in the lobectomy group (p<0.05). Furthermore, no significant difference was observed in MVV%, FVC% and FEV1% between the two groups before operation (p>0.05). Meanwhile, the segmentectomy group had evidently lower VAS scores at 1 d, 3 d and 5 d postoperatively than those in the lobectomy group (p<0.05). Besides, there was a much lower total incidence of complications in the segmentectomy group than that in the lobectomy group (p<0.05). Compared with lobectomy, thoracoscopic segmentectomy is more effective in the treatment of stage I NSCLC, with less bleeding and mild pain, which can alleviate pulmonary function injury and reduce postoperative complications that is conducive to the improved prognosis of patients.

Postoperative lung cancer surveillance: the highs and lows of computerized tomographic scanning.

Radiation dose reduction has been a topic of great interest in the last decade. In this study, Nakada and colleagues address a very important contributor of radiation exposure in today’s world, i.e. lung cancer surveillance [1]. Since the USPSTF’s recommendations on lung cancer screening, there has been an increase in the detection and treatment of early-stage lung cancers [2]. With the recent screening guidelines including younger patients, we are bound to see an increase in the pool of patients that are now exposed to intensive surveillance with computerized tomographic (CT) scans after lung cancer treatment. Nakada et al. make a case here to balance our surveillance strategy with the radiation exposure that we commit these patients to. They present a retrospective study of 416 patients who underwent lobectomy or segmentectomy for stage I non-small-cell lung cancer (NSCLC) and were surveilled with low-dose CT (LDCT) or conventional CT with a median follow-up time of 57 months. In the propensity score-matched analysis, they did not find a significant difference in the recurrence-free survival or the overall survival between the 2 groups.

Comparison of extended segmentectomy with traditional segmentectomy for stage I lung cancer

BackgroundFor stage I non-small cell lung cancer (NSCLC), lobectomy and segmentectomy are still controversial operations. Extended segmentectomy was proposed to make larger safe margins than segmentectomy. Image-guided video-assisted thoracoscopic surgery (iVATS) is useful to accomplish extended segmentectomy. We aimed to compare the effects of iVATS extended segmentectomy to the effects of traditional segmentectomy for stage I NSCLC.MethodsThis study is a retrospective analysis in a single institute. Patients with stage I NSCLC who received segmentectomy between January 2017 and September 2020 were included. Patients were distributed to iVATS extended segmentectomy (group A), and traditional segmentectomy (group B). The impacts of the different surgical methods on resection margin were assessed.ResultsThere were 116 patients enrolled in this study. Sixty-two patients distributed in group A, and the other 54 patients in group B. The resection margin to a staple line was 17.94 mm in group A versus 14.15 mm in group B, p = 0.037. The margin/tumor diameter ratio was 2.08 in group A versus 1.39 in group B, p = 0.003. The enough margin rate was 75.81% and 57.41%, respectively, for group A and group B. The subgroup analysis of iVATS extended segmentectomy showed that T1a lesions had larger margin distances than did T1b lesions (19.85 mm vs. 14.83 mm, p = 0.026).ConclusionsThe iVATS extended segmentectomy can provide more resection margin than traditional segmentectomy. Segmentectomy is more suitable to perform when the nodule’s diameter is less than 10 mm.

Surgical choice for patients with stage I non-small-cell lung cancer \u22642\u2009cm: an analysis from surveillance, epidemiology, and end results database

BackgroundNo consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer (NSCLC) ≤ 2 cm. The aim of this study is to investigate the appropriate surgical procedure for stage I NSCLC ≤2 cm.MethodsPatients with stage I NSCLC ≤2 cm received wedge resection, segmentectomy, lobectomy between January 2004 and December 2015 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Data were stratified by age, gender, race, side, location, grade, histology, extent of lymphadenectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients received wedge resection, segmentectomy, lobectomy. Univariate analysis and multivariable Cox regression were performed to identify the prognostic factors of OS and LCSS.ResultsA total of 16,511 patients with stage I NSCLC ≤2 cm were included in this study, of whom 2945 patients were classified as stage I NSCLC ≤1 cm. Lobectomy had better OS and LCSS when compared with wedge resection in patients with NSCLC ≤2 cm. Only OS favored lobectomy compared with segmentectomy in stage I NSCLC>1 to 2 cm. Multivariable analysis showed that segmentectomy had similar OS and LCSS compared with lobectomy in patients with stage I NSCLC ≤2 cm. Lymph node dissection (LND) was associated with better OS in patients with NSCLC ≤2 cm and better LCSS in patients with stage I NSCLC>1 to 2 cm.ConclusionsSegmentectomy showed comparable survival compared with lobectomy in patients with stage I NSCLC ≤2 cm. LND can provide more accurate pathological stage, may affect survival, and should be recommended for above patients.

Wedge Resection Offers Similar Survival to Segmentectomy for Typical Carcinoid Tumors

Current guidelines recommend anatomic lung resection of typical bronchopulmonary carcinoids. Typical carcinoid tumors have excellent prognosis and sublobar resection has been associated with noninferior long-term survival. It's unclear whether wedge resection is acceptable for small typical carcinoid tumors. We hypothesize there is no difference in survival between wedge resection and segmentectomy for Stage I typical bronchopulmonary carcinoid tumors. Using the National Cancer Database from 2010 to 2016, we identified clinical T1N0M0 typical bronchopulmonary carcinoid tumors by wedge resection or segmentectomy. Short-term outcomes included length of stay, lymph nodes evaluated, pathologic node status, positive margin status, and 90-day mortality. Primary outcome was overall survival and estimated using Kaplan-Meier survival analysis. 821 patients were identified: 677 receiving wedge resection, 144 receiving segmentectomy. Segmentectomy was more commonly performed in an academic setting (70.0% vs 57.3%, P = 0.005). The mean tumor size for segmentectomy was 1.7 cm versus 1.4 cm for wedge resection (P < 0.001). There was no difference in LOS, positive margin status, and 90-day mortality between groups. There were significantly more lymph nodes evaluated in segmentectomy patients (median 4 vs 0, P < 0.001), but there was no difference in positive lymph node status (5.3% vs 2.6%, P = 0.165). The OS was similar between wedge and segmental resection (P = 0.613): 3-year survival (93.5% vs 92.8%) and 5-year survival (83.8% vs 84.9%). Wedge resection and segmentectomy have similar survival for Stage I typical bronchopulmonary carcinoids in a large national database. This analysis suggests nonanatomic, parenchymal-sparing resection should be considered an appropriate alternative for Stage I typical bronchopulmonary carcinoids.

Four cases of completion lobectomy for locally relapsed lung cancer after segmentectomy

BackgroundAlthough completion lobectomy is the treatment of choice for local recurrence of non-small cell lung cancer after segmentectomy, few cases have been reported. We report four patients who underwent completion lobectomies for staple line recurrence after segmentectomy for stage I non-small cell lung cancer.Case presentationThree women aged 65, 82, and 81 years underwent completion lower lobectomy after superior segmentectomy of the same lobe for local recurrence of stage I non-small cell lung cancer. A 67-year-old man, who had a tumor recurrence on the staple line after apical segmentectomy with superior mediastinal nodal dissection for stage I non-small cell lung cancer, underwent completion right upper lobectomy. These four patients underwent segmentectomy because of comorbidities or advanced age. Local recurrence was confirmed by computed tomography-guided needle biopsy. The interval between the two operations was 37, 39, 41, and 16 months, respectively. Although minimal hilar adhesion was seen for the three completion lower lobectomies, tight adhesions after apical segmentectomy made completion right upper lobectomy quite difficult to dissect, which led to injury of the superior pulmonary vein. No recurrence was recorded after completion lobectomies for 62, 70, 67, and 72 months, respectively.ConclusionsAlthough completion lobectomy is one of the most difficult modes of resection, among several completion lobectomies, completion lower lobectomy after superior segmentectomy without superior mediastinal nodal dissection was relatively easy to perform because of fewer hilar adhesions.

A Meta-Analysis Comparing Lobectomy versus Segmentectomy in Stage I Non-Small Cell Lung Cancer.

Lobectomy is considered the standard strategy for early-stage non-small cell lung cancer (NSCLC). However, sublobar resection for NSCLC has recently received increased attention. The objective of this study was to compare 5-year survival, recurrence-free survival, postoperative mortality, and postoperative morbidities in patients who received segmentectomy versus those who received lobectomy through a meta-analysis. Sixteen studies were included and the combined hazard ratios or odds ratios were calculated. The results revealed that the 5-year survival rate after segmentectomy was comparable to that of lobectomy for stage IA NSCLC. However, segmentectomy for stage I NSCLC had lower rates of postoperative mortality and morbidities than lobectomy.

P3.16-26 Anatomic Segmentectomy in Stage I Non-Small-Cell Lung Cancer Reveals Equivalent Long-Term Outcomes Compared to Lobectomy

P3.16-26 Anatomic Segmentectomy in Stage I Non-Small-Cell Lung Cancer Reveals Equivalent Long-Term Outcomes Compared to Lobectomy

Intentional Segmentectomies for Stage I Lung Cancer: An Up-to-Date Systematic Review

The role of this systematic review is to analyse and compare with a meta-analytic approach the outcomes of lobectomy versus intentional segmentectomy in the surgical treatment of stage I non-small cell lung cancer (NSCLC) as reported in the largest studies on the subject published to date. Regarding the results, most of these studies were based on the retrospective data. The size of the cohorts varied from 17 to 11,520 with a total number of 31,684 patients. The pooled hazard ratio was 1.08 (95% CI = 0.97–1.21; p = 0.16). The survival in the lobectomy group was not superior to patients treated with intentional segmentectomy in stage I NSCLC. A large numbered, prospective, randomised trials are needed to assess the feasibility of intentional segmentectomy and its oncologic value in this group of patients, in order to dissolve the questions raised by retrospective data.

A critical analysis of segmentectomy versus lobectomy for non-small-cell lung cancer

Bao et al. [1] should be commended for completing a thorough and timely meta-analysis to compare the survival outcomes of segmentectomy versus lobectomy for Stage I non-small-cell lung cancer (NSCLC). This analysis represents the first of its kind to distinguish segmentectomies from wedge resections, an important distinction from both an oncological and technical perspective that has been overlooked in previous meta-analyses that compared ‘sublobar resections’ with lobectomy procedures [2, 3]. We concur with the authors that the current literature lacks robust high-level evidence on this topic and a meta-analysis of observational studies may provide insightful guidance for clinicians. Results of this study found that patients who underwent segmentectomy for Stage I, IA and IA (2–3 cm) NSCLC were associated with inferior combined overall survival (OS) and cancer-specifi cs urvival (CSS) outcomes compared with those who underwent lobectomy. However, patients with Stage IA (≤2 cm) NSCLC had no statistically significant difference in survival compared with lobectomy. It is imperative to analyse these results in detail to avoid misleading conclusions. In two of the four analysed subgroups, Stage IA and Stage IA (2–3 cm), OS outcomes were significantly worse after segmentectomy, but CSS was not significant. The combined OS/CSS were significant in both subgroups, and the authors concluded that patients who underwent segmentectomy in these cohorts resulted in inferior outcomes. However, it must be emphasized that patient baseline characteristics between these two treatment groups differed significantly, and patients were often selected for segmentectomies due to significant comorbidities and limited pulmonary reserve prohibiting them from lobectomy procedures [4, 5]. In such cases, differences in OS may be misleading compared with CSS, as patients died due to causes unrelated to NSCLC and the oncological efficacy of their surgical procedures. Hence, worse OS outcomes in the segmentectomy group may be a reflection of their patient characteristics rather than their operative outcome. Similarly, a combined statistic of OS and CSS may overestimate the adverse survival outcomes of segmentectomy procedures. To address the issue of differing patient baseline characteristics, Tsutani et al. [6] recently published a propensity-score analysis involving 481 patients with clinical Stage IA adenocarcinoma who were subsequently matched into 81 pairs according to clinicopathological factors. Results of this study demonstrated no differences in regard to OS and recurrence-free survival at 3 years. In our opinion, it is no longer controversial to perform sublobar resections for patients with NSCLC who are deemed ineligible for lobectomy procedures due to comorbidities or limited pulmonary function. The area of interest lies with the cohort of patients who can tolerate either a segmentectomy or a lobectomy procedure. For this growing patient population who are diagnosed with early stage NSCLC through more aggressive screening programmes, oncological efficacy needs to be balanced with pulmonary preservation and potentially reduced perioperative complications associated with segmentectomy. Future analyses should aim to differentiate data from studies that included ‘compromised’ patients who underwent sublobar resections as a result of their inability to undergo lobectomy, or ‘intentional’ patients who could have tolerated either procedure.

Survival After Lobectomy Versus Segmentectomy for Stage I Non-Small Cell Lung Cancer: A Population-Based Analysis

Data comparing survival after lobectomy versus that after segmentectomy for stage I non-small cell lung cancer (NSCLC) are limited to single-institution observational studies and 1 clinical trial. We sought to determine if lobectomy offers a survival advantage over segmentectomy for stage I NSCLC based on population-based data. Using the Surveillance Epidemiology and End Results (SEER) database (1998 to 2007), we identified patients who underwent either anatomic segmentectomy or lobectomy. Wedge resections were excluded. Analysis was limited to patients with stage I adenocarcinoma or squamous cell carcinoma. After stratifying patients based on tumor size (less than or equal to 2.0 cm, 2.1 to 3.0 cm, and 3.1 to 7.0 cm), we assessed for association between extent of resection and survival using the Kaplan-Meier method. To adjust for potential confounding variables, we used Cox proportional hazards regression models. There were 14,473 patients who met our inclusion criteria. Lobectomy conferred superior unadjusted overall (p < 0.0001) and cancer-specific (p = 0.0053) 5-year survival compared with segmentectomy. Even after adjusting for patient factors, tumor characteristics, and geographic location, we noted that patients who underwent lobectomy had superior overall and cancer-specific survival rates, regardless of tumor size. Squamous cell histologic type, male sex, low lymph node counts, and increasing age, tumor size, and grade were all independent negative prognostic factors. Using a population-based data set, we found that lobectomy confers a significant survival advantage compared with segmentectomy. Our results provide additional evidence supporting the role of lobectomy as the standard of care for resection of stage I NSCLC regardless of tumor size.

Anatomic Segmentectomy for Stage I Non-Small Cell Lung Cancer in the Elderly

Anatomic Segmentectomy for Stage I Non-Small Cell Lung Cancer in the Elderly

Anatomic segmentectomy for stage I non-small cell lung cancer: Comparison of outcomes with the VATS versus open approach

7616 Background: Anatomic segmentectomy for early-stage NSCLC has been proposed as a means of achieving a complete resection in high-risk patients with poor lung function, who might not otherwise tolerate conventional lobectomy. Historically, anatomic segmentectomy has been associated with increased recurrence rates and postoperative air leaks. In the current study, we present our experience with VATS versus open segmentectomy for stage I NSCLC. Methods: A total of 181 consecutive anatomic segmentectomies (114 Open, 67 VATS) were performed for Stage IA (n=110) or IB (n=71) NSCLC from 2002–2006. A VATS approach was employed in 67 patients, and an open approach in 114 patients. Outcome variables include hospital course, complications, mortality, recurrence patterns and survival. Results: The mean age was 70 years (range: 45–100). Average tumor size was 2.3 cm (2.0 cm VATS; 2.4 cm open, NS). Lymph node sampling or dissection was performed in 169 (93%) of patients with an average node harvest of 8.2 nodes (Open = 9.2; VATS = 6.2, p=0.006). There were two perioperative deaths (1.1%), both open. Complications occurred in 59 patients (33%). Median length of stay was 6 days (VATS=5, Open=7). Mean follow-up was 15.6 months. There were fewer major (7 vs. 31, p=0.005) and infectious (3 vs. 12%, p=0.026) complications in the VATS group, with no significant difference in pulmonary complications or air leaks. Twenty-nine recurrences (16%; VATS=7, Open=22) occurred at a mean of 12.7 months [11 locoregional (6%), 18 distant (10%)]. Overall mortality, complications, recurrence and two-year actuarial survival (78%) were similar between VATS and open segmentectomy. Conclusions: VATS segmentectomy can be performed safely with acceptable morbidity, mortality, recurrence and survival. The VATS approach affords a shorter length of stay and fewer postoperative complications (major and infectious) compared with open techniques. The potential benefits of segmentectomy will need to be further validated by prospective, randomized trials (ACOSOG Z4032). Sublobar resection techniques represent an important adjunct in treating compromised patients with early stage NSCLC. No significant financial relationships to disclose.