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01-08-2018 | Original Scientific Report with Video

Segmentectomy Versus Lobectomy for Radiologically Pure Solid Clinical T1a-bN0M0 Lung Cancer

Authors: Norifumi Tsubokawa, Yasuhiro Tsutani, Yoshihiro Miyata, Yoshinori Handa, Keizo Misumi, Hideaki Hanaki, Eisuke Hida, Morihito Okada

Published in: World Journal of Surgery | Issue 8/2018

Abstract

Background

Segmentectomy for radiologically pure solid tumors is still controversial because these tumors are more aggressive in malignancy than those with ground-glass opacity. This study aimed to determine the feasibility of intentional segmentectomy for pure solid small-sized lung cancer.

Methods

We retrospectively analyzed 96 radiologically pure solid tumors in clinical T1a-bN0M0 lung cancer. Patients whose tumor was located at a central region or right middle lobe were excluded. Forty-four patients who underwent lobectomy were compared with 52 those who underwent segmentectomy. Segmentectomy got converted to lobectomy if lymph node metastases or inadequate surgical margin was confirmed. Factors affecting survival were assessed using Cox regression. Propensity score stratification analysis was also performed.

Results

Eight patients (8%) were identified as a histological type other than adenocarcinoma or squamous cell carcinoma. Moreover, 14 patients (14%) displayed lymph node metastasis. Among those who underwent segmentectomy, nine patients (16%) were converted to lobectomy due to lymph node metastasis or inadequate surgical margin. The 3-year recurrence-free survival rates were 84.1 and 82.2% in patients who underwent segmentectomy and lobectomy, respectively (P = 0.745). In addition, the recurrence-free survival was not statistically significant between segmentectomy and lobectomy, as determined via multivariable Cox regression analysis (hazard ratio 1.11; 95% confidence interval 0.40–3.06), even after propensity score stratification (hazard ratio 1.17; 95% confidence interval 0.38–3.65).

Conclusions

Segmentectomy with intraoperative assessment of lymph node metastasis and adequate surgical margin may be a feasible surgical procedure for pure solid tumors in clinical T1a-bN0M0 lung cancer.

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Aberle DR, Adams AM, Berg CD et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409CrossRefPubMed

Yoshida J, Nagai K, Yokose T et al (2005) Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience. J Thorac Cardiovasc Surg 129:991–996CrossRefPubMed

Tsutani Y, Miyata Y, Yamanaka T et al (2013) Solid tumors versus mixed tumors with a ground-glass opacity component in patients with clinical stage IA lung adenocarcinoma: prognostic comparison using high-resolution computed tomography findings. J Thorac Cardiovasc Surg 146:17–23CrossRefPubMed

Okada M, Nakayama H, Okumura S et al (2011) Multicenter analysis of high-resolution computed tomography and positron emission tomography/computed tomography findings to choose therapeutic strategies for clinical stage IA lung adenocarcinoma. J Thorac Cardiovasc Surg 141:1384–1391CrossRefPubMed

Tsutani Y, Miyata Y, Nakayama H et al (2014) Segmentectomy for clinical stage IA lung adenocarcinoma showing solid dominance on radiology. Eur J Cardiothorac Surg 46:637–642CrossRefPubMed

Suzuki K, Kusumoto M, Watanabe S et al (2006) Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact. Ann Thorac Surg 81:413–419CrossRefPubMed

Inoue M, Minami M, Sawabata N et al (2010) Clinical outcome of resected solid-type small-sized c-stage IA non-small cell lung cancer. Eur J Cardiothorac Surg 37:1445–1449CrossRefPubMed

Hattori A, Suzuki K, Matsunaga T et al (2012) Is limited resection appropriate for radiologically “solid” tumors in small lung cancers? Ann Thorac Surg 94:212–215CrossRefPubMed

Koike T, Kitahara A, Sato S et al (2016) Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg 101:1354–1360CrossRefPubMed

10.

Nishio W, Yoshimura M, Maniwa Y et al (2016) Re-assessment of intentional extended segmentectomy for clinical T1aN0 non-small cell lung cancer. Ann Thorac Surg 102(5):1702–1710CrossRefPubMed

11.

Goldstraw P, Chansky K, Crowley J et al (2016) The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 11:39–51CrossRefPubMed

12.

Travis WD, Brambilla E, Nicholson AG et al (2015) The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol 10:1243–1260CrossRefPubMed

13.

Okada M, Mimura T, Ikegaki J et al (2007) A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg 133:753–758CrossRefPubMed

14.

Sawabata N, Ohta M, Matsumura A et al (2004) Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. Ann Thorac Surg 77:415–420CrossRefPubMed

15.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

16.

Kato H, Ichinose Y, Ohta M et al (2004) A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med 350:1713–1721CrossRefPubMed

17.

Hamada C, Tanaka F, Ohta M et al (2005) Meta-analysis of postoperative adjuvant chemotherapy with tegafur-uracil in non-small-cell lung cancer. J Clin Oncol 23:4999–5006CrossRefPubMed

18.

Austin PC (2014) The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med 33:1242–1258CrossRefPubMed

19.

Rivera MP, Mehta AC, Wahidi MM (2013) Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e142S–165SCrossRefPubMed

20.

Tsubota N, Ayabe K, Doi O et al (1998) Ongoing prospective study of segmentectomy for small lung tumors. Study Group of Extended Segmentectomy for Small Lung Tumor. Ann Thorac Surg 66:1787–1790CrossRefPubMed

21.

Nomori H, Mori T, Izumi Y et al (2012) Is completion lobectomy merited for unanticipated nodal metastases after radical segmentectomy for cT1 N0 M0/pN1-2 non-small cell lung cancer? J Thorac Cardiovasc Surg 143:820–824CrossRefPubMed

22.

Khullar OV, Liu Y, Gillespie T et al (2015) Survival after sublobar resection versus lobectomy for clinical stage IA lung cancer: an analysis from the National Cancer Data Base. J Thorac Oncol 10:1625–1633CrossRefPubMedPubMedCentral

23.

Sienel W, Stremmel C, Kirschbaum A et al (2007) Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localisation and width of resection margins-implications for patient selection for segmentectomy. Eur J Cardiothorac Surg 31:522–527 (discussion 527–528) CrossRefPubMed

24.

Nakamura K, Saji H, Nakajima R et al (2010) A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol 40:271–274CrossRefPubMed

25.

National Institutes of Health. National Cancer Institute. CALGB-140503. Phase III randomized study of lobectomy versus sublobar resection in patients with small peripheral stage IA non-small cell lung cancer. http://www.cancer.gov/clinicaltrials/calgb-140503. Accessed 16 March 2010

Title: Segmentectomy Versus Lobectomy for Radiologically Pure Solid Clinical T1a-bN0M0 Lung Cancer
Authors: Norifumi Tsubokawa
Yasuhiro Tsutani
Yoshihiro Miyata
Yoshinori Handa
Keizo Misumi
Hideaki Hanaki
Eisuke Hida
Morihito Okada
Publication date: 01-08-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4514-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Segmentectomy Versus Lobectomy for Radiologically Pure Solid Clinical T1a-bN0M0 Lung Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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