Comparison between a Case-Matched Analysis of Left Upper Lobe Trisegmentectomy and Left Upper Lobectomy for Small Size Lung Cancer Located in the Upper Division

 

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Abstract

Background: Although an increasing number of approaches for pulmonary segmentectomy to treat early lung cancer are being used, there have been few reports on left upper lobe trisegmentectomy, which is midway between single segmentectomy and lobectomy, for lung cancer. Methods: We retrospectively reviewed the medical charts of 86 clinical stage I case-matched patients with a tumor size of less than 2.0 cm in diameter located in the left upper division who underwent resection between June 1998 and December 2005. The patients were divided into two groups as follows: LTS (31), left upper lobe trisegmentectomy; LUL (55), left upper lobectomy. We evaluated these groups with respect to several factors. Results: The characteristics of the two groups (LTS vs. LUL) demonstrated no significant differences with respect to gender, histological type, tumor size, or upstaging of pathological node, or the mode of video-assisted thoracic surgery (VATS). Patients with LTS had a significantly lower pulmonary function compared to the LUL group. There were no significant differences between the two groups with respect to factors such as blood loss and duration of chest tube drainage. Morbidity and recurrence rates did not differ between the two groups, and there was no mortality in our series. The overall survival rate at 5 years was 69.7 % in the LTS and 72.5 % in the LUL group. There was no significant difference in survival rates between the LTS and the LUL group after resection. Conclusion: LTS may be suitable as a standard treatment if the tumor is small and the suspected margins are well away from the lingula.

References

• 1 Kodama K, Doi O, Higashiyama M, Yokouchi H. Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study.  J Thorac Cardiovasc Surg. 1997;  114 347-353
  CrossrefPubMedGoogle Scholar
• 2 Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T. Prospective study of extended segmentectomy for small lung tumors: the final report.  Ann Thorac Surg. 2002;  73 1055-1059
  CrossrefPubMedGoogle Scholar
• 3 Lung Cancer Study Group . Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer.  Ann Thorac Surg. 1995;  60 615-622
  CrossrefPubMedGoogle Scholar
• 4 Bastarrika G, Garcia-Velloso M J, Lozano M D. et al . Early lung cancer detection using spiral computed tomography and positron emission tomography.  Am J Respir Crit Care Med. 2005;  171 1378-1383
  CrossrefPubMedGoogle Scholar
• 5 Nakata M, Sawada S, Saeki H. et al . Prospective study of thoracoscopic limited resection for ground-glass opacity selected by computed tomography.  Ann Thorac Surg. 2003;  75 1601-1605
  CrossrefPubMedGoogle Scholar
• 6 Kashiwabara K, Kohshi S. Outcome in patients with lung cancer invisible on chest roentgenograms but detected only by helical computed tomography.  Respirology. 2006;  11 592-597
  CrossrefPubMedGoogle Scholar
• 7 Roviaro G, Varoli F, Vergani C, Nucca O, Maciocco M, Grignani F. Long-term survival after videothoracoscopic lobectomy for stage I lung cancer.  Chest. 2004;  126 725-732
  CrossrefPubMedGoogle Scholar
• 8 Iwasaki A, Shirakusa T, Shiraishi T, Yamamoto S. Results of video-assisted thoracic surgery for stage I/II non-small cell lung cancer.  Eur J Cardiovasc Surg. 2004;  26 158-164
  PubMedGoogle Scholar
• 9 Martin-Ucar A E, Nakas A, Pilling J E, West K J, Waller D A. A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients.  Eur J Cardiothorac Surg. 2005;  27 675-679
  CrossrefPubMedGoogle Scholar
• 10 Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection.  J Thorac Cardiovasc Surg. 2005;  129 87-93
  CrossrefPubMedGoogle Scholar
• 11 Bando T, Yamagihara K, Ohtake Y. et al . A new method of segmental resection for primary lung cancer: intermediate results.  Eur J Cardiothorac Surg. 2002;  21 894-899
  CrossrefPubMedGoogle Scholar
• 12 Sakao Y, Miyamoto H, Yamazaki A, Ou S, Shiomi K, Sonobe S, Sakuraba M. The spread of metastatic lymph nodes to the mediastinum from left upper lobe cancer: results of superior mediastinal nodal dissection through a median sternotomy.  Eur J Cardiothorac Surg. 2006;  30 543-547
  CrossrefPubMedGoogle Scholar
• 13 Zeiher B G, Gross T J, Kern J, Lanza L L, Peterson M W. Predicting postoperative pulmonary function in patients undergoing lung resection.  Chest. 1995;  108 68-72
  CrossrefPubMedGoogle Scholar
• 14 Martin-Ucar A E, Nakas A, Pilling J E, West K J, Waller D A. A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients.  Eur J Cardiothorac Surg. 2005;  27 675-679
  CrossrefPubMedGoogle Scholar
• 15 Houck W V, Fuller C F, MaKenna R. Video-assisted thoracic surgery upper lobe trisegmentectomy for early-stage left apical lung cancer.  Ann Thorac Surg. 2004;  78 1858-1860
  CrossrefPubMedGoogle Scholar
• 16 Jones D R, Stiles B M, Denlinger C E, Antippa P, Daniel T M. Pulmonary segmentectomy: results and complications.  Ann Thorac Surg. 2003;  76 343-348
  CrossrefPubMedGoogle Scholar
• 17 Yamato Y, Tsuchida M, Watanabe T. et al . Early results of a prospective study of limited resection for bronchioloalveolar adenocarcinoma of the lung.  Ann Thorac Surg. 2001;  71 971-974
  CrossrefPubMedGoogle Scholar

Dr. Akinori Iwasaki

Department of Thoracic Surgery
School of Medicine
Fukuoka University

45-1, 7-chome Nanakuma, Jonan-ku

Fukuoka 814-0180

Japan

Phone: + 81 9 28 01 10 11

Fax: + 81 92 86 18 271

Email: akinori@fukuoka-u.ac.jp