Pulmonary segmentectomy for early stage non-small cell lung cancer: when, for which cases and how
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PROVIDER: S-EPMC10089869 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
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Project description:BackgroundThoracoscopic segmentectomy is increasingly used in the surgical treatment of early-stage non-small cell lung cancer. However, it remains unclear whether pulmonary function loss after thoracoscopic lung resection is in direct proportion to the number of resected segments, and thus intentional thoracoscopic segmentectomy has the function-preserving advantage over thoracoscopic lobectomy.MethodsIn this prospective observational study, spirometry tests were performed preoperatively and 6 months postoperatively. The observed functional loss was compared with the expected loss estimated by the segment counting method. Resection extent index was introduced as the number of resected segments to total number of segments in the corresponding lobe. Spirometry changes after thoracoscopic lobectomy and intentional thoracoscopic segmentectomy were compared using propensity score matching.ResultsThere were 338 thoracoscopic lobectomies and 321 thoracoscopic segmentectomies. Overall, the observed pulmonary function loss after segmentectomy was significantly less than after lobectomy. But the observed functional loss was significantly greater than the expected loss after segmentectomy. And pulmonary function loss per segment resected was almost doubled after segmentectomy comparing to lobectomy. For segmentectomies with a resection extent index less than 0.5, especially single segmentectomies, pulmonary function loss was significantly less than after corresponding lobectomies. Otherwise, no significant differences in spirometry changes between lobectomies and segmentectomies were detected.ConclusionsPulmonary function loss after thoracoscopic lung resection cannot be accurately evaluated by the number of resected segments. According to the resection extent index, intentional thoracoscopic segmentectomy may help preserve more pulmonary function than thoracoscopic lobectomy only when less than half of the corresponding lobe are resected.
| S-EPMC8674599 | biostudies-literature
Project description:ObjectivesDespite clinical trials supporting the efficacy of segmentectomy for early-stage non-small cell lung cancer (NSCLC), a previous report indicated its limited efficacy in younger patients, raising concerns about its indication.MethodsPatients aged <70 years with radiologically solid-dominant clinical stage IA NSCLC ≤2 cm who underwent lobectomy or segmentectomy at three institutions between 2010 and 2017 were enrolled. Propensity scores were estimated to adjust for confounding variables (age, sex, smoking history, tumour location, size, ground-glass opacity, maximum standardized uptake value and histological type). To elucidate the prognostic impact of surgical indications in the late postoperative phase, restricted mean survival time (RMST) from 0 to 5 and 8 years was also determined.ResultsOverall, 388 patients with a median age of 63 years were enrolled. Overall survival (OS) (hazard ratio [HR], 0.447; 95% confidence interval [CI], 0.152-1.316) and recurrence-free survival (RFS) (HR, 0.638; 95% CI, 0.335-1.216) did not differ significantly between the segmentectomy (n = 114) and lobectomy groups (n = 274). In the propensity score matching of 100 pairs, OS (HR, 0.577; 95% CI, 0.162-2.056) and RFS (HR, 0.945; 95% CI, 0.408-2.191) were comparable between the segmentectomy and lobectomy groups. Regarding OS in the segmentectomy and lobectomy groups, the 5- and 8-year RMST were 4.95 years versus 4.92 years (difference: 0.02 years; 95% CI, -0.09-0.13; P = 0.699) and 7.82 years versus 7.69 years (difference: 0.12 years; 95% CI, -0.17-0.42; P = 0.420), respectively.ConclusionsSegmentectomy is a viable option for younger patients with early-stage NSCLC, suggesting that indications for segmentectomy need not vary by age.
| S-EPMC11879302 | biostudies-literature
Project description: Not available
| S-EPMC11240445 | biostudies-literature
Project description: Not available
| S-EPMC9992610 | biostudies-literature
Project description:ObjectivesAlthough segmentectomy is an acceptable alternative to lobectomy for peripheral small-sized non-small-cell lung cancer, the effectiveness of segmentectomy for inner lesions remains unknown. The aim of this study was to examine the feasibility of segmentectomy in comparison with lobectomy for inner lesions.MethodsWe retrospectively analysed 570 patients with small (≤2 cm) cN0 non-small-cell lung cancer who underwent segmentectomy or lobectomy between January 2007 and March 2021. We focused on patients with lesions located in the inner two-thirds, which were determined using three-dimensional computed tomography (n = 227). After propensity score matching analysis based on sex, age, pulmonary function, serum carcinoembryonic antigen level, radiographic tumour findings and tumour location, we compared the surgical and oncological outcomes in patients who underwent segmentectomy (n = 66) and lobectomy (n = 66).ResultsPostoperative mortality or morbidity did not differ significantly between the 2 groups. The 5-year recurrence-free and overall survival rates in the segmentectomy and lobectomy groups were 93.6% vs 84.1% and 95.8% vs 87.9%, respectively. The differences between 2 groups were not significant (P = 0.62 and P = 0.23, respectively). The 2 groups also showed no differences in loco-regional recurrence. Multivariable Cox regression analysis revealed that segmentectomy had a comparable impact on recurrence-free survival (hazard ratio, 0.61; 95% confidence interval, 0.17-2.03; P = 0.43).ConclusionsSegmentectomy for inner-located small-sized non-small-cell lung tumours could be an acceptable treatment in comparison with lobectomy.
| S-EPMC9468593 | biostudies-literature
Project description:Lung cancer is a worldwide malignancy with high morbidity and mortality in the world. With the application of low-dose spiral computed tomography in the screening and diagnosis of lung cancer, more lung cancers are detected at an early stage and cured by surgical treatment. Anatomical lobectomy has long been the standard procedure for the treatment of early stage non-small cell lung cancer. However, whether intentional segmentectomy can be more used remains controversial. And this paper focuses on the question.?.
| S-EPMC6717873 | biostudies-literature
Project description: Not available
| S-EPMC7656425 | biostudies-literature
Project description:BackgroundSubxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) is more technically challenging than intercostal uniportal video-assisted thoracoscopic surgery (UVATS), especially in more complex procedures such as segmentectomy. We therefore aimed to investigate the worthiness of undertaking the more demanding subxiphoid approach in patients who had undergone anatomical segmentectomy for stage IA non-small cell lung cancer (NSCLC).MethodsA total of 491 patients were included in our study who had undergone anatomical segmentectomy for stage IA non-small cell lung cancer from September 2014 to April 2018. They were divided into two groups; 278 patients in the UVATS group and 213 patients in the SVATS group. Different perioperative variables, postoperative pain, quality of life and cost were analyzed and compared between both groups.ResultsThe SVATS group showed a significantly longer operative time (P = 0.007) and more operative blood loss than the intercostal group (P = 0.004). There was no significant difference between both groups regarding postoperative drainage, duration of chest tube, postoperative hospital stay, operative conversion or postoperative complications. The SVATS group showed a significantly lower pain score postoperatively (P < 0.001). In addition, the SVATS group showed a significantly better postoperative quality of life score along the first postoperative year (P < 0.001). UVATS segmentectomy appeared to be significantly cheaper than SVATS segmentectomy (P < 0.001).ConclusionsSVATS segmentectomy for stage IA lung cancer is a safe procedure that is worth proceeding with as it is associated with better postoperative pain and better quality of life in the first postoperative year. Further studies are recommended to evaluate the actual cost-effectiveness of SVATS segmentectomy.Key points• Significant findings of the study Subxiphoid uniportal approach for pulmonary segmentectomy is safe and feasible approach. It has better postoperative pain and better quality of life than the uniportal intercostal approach; however, it is more expensive. • What this study adds Subxiphoid uniportal approach for pulmonary segmentectomy gives a better quality of life in Chinese patients than the intercostal approach; however, it is more expensive.
| S-EPMC7262898 | biostudies-literature
Project description:BackgroundThe question of whether segmentectomy and lobectomy have similar survival outcomes for patients with early-stage non-small cell lung cancer (NSCLC) is a matter of debate.MethodsA cohort study and randomized controlled trial were included, comparing segmentectomy and lobectomy, by utilizing computerized access to the Pubmed, Web of Science, and Cochrane Library databases up until July 2022. The Cochrane Collaboration tool was used to evaluate the randomized controlled trials, while the Newcastle-Ottawa Scale (NOS) was used to evaluate the cohort studies. Sensitivity analyses were also carried out.ResultsThe analysis incorporated 17 literature studies, including one randomized controlled trial and 16 cohort studies, and was divided into a segmentectomy group (n = 2081) and a lobectomy group (n = 2395) based on the type of surgery the patient underwent. Each study was followed up from 27 months to 130.8 months after surgery. Over survival (OS): HR = 1.14, 95%CI(0.97,1.32), P = 0.10; disease-free survival (DFS): HR = 1.13, 95%CI(0.91,1.41), P = 0.27; recurrence-free survival (RFS): HR = 0.95, 95%CI(0.81,1.12), P = 0.54.ConclusionThe results of the study suggest that the survival outcomes of the segmentectomy group were not inferior to that of the lobectomy group. Segmentectomy should therefore be considered as a treatment option for early stage NSCLC.
| S-EPMC11193294 | biostudies-literature
Project description:Objectives: To evaluate the safety and feasibility of a novel surgical technique ("non-triangle plane" technique) of two-port (mini-utility) video-assisted thoracic surgery (VATS) atypical segmentectomy (S3+S1+2c) with tunneling stapler for small-sized non-small-cell lung cancers (NSCLCs) located in left S3 close to the intersegmental plane between S3 and S1+2c. Materials and Methods: This retrospective descriptive study included 16 patients who, between April 2016 and December 2019, underwent a single two-port (mini-utility) VATS atypical segmentectomy (S3+S1+2c) with tunneling stapler technique for small-sized NSCLCs with a ground-glass opacity (GGO) rate of more than 50% by a constant surgical team in two hospitals. Perioperative data and survival data were collected and retrospectively analyzed. Postoperative follow-up was performed every 6 months. Results: Six patients were with adenocarcinoma in situ, and ten were with minimally invasive adenocarcinoma. The mean surgical margin was 14.06 ± 3.02 mm. The mean operation time was 53.88 ± 9.76 min. The mean duration of chest tube drainage was 4 ± 1.21 days, and the median length of postoperative hospital stay was 4 days. There was no perioperative morbidity and mortality. The median follow-up was 47.5 months (17-61 months). No recurrences occurred, and all patients were still alive at the last registered follow-up (May 31, 2021). Conclusion: Two-port (mini-utility) VATS atypical segmentectomy (S3+S1+2c) with tunneling stapler technique is a safe and feasible option for the treatment of small-sized NSCLCs located in left S3 close to the intersegmental plane between S3 and S1+2c.
| S-EPMC8576117 | biostudies-literature