Comparison of the Surgical Outcomes of Thoracoscopic Lobectomy, Segmentectomy, and Wedge Resection for Clinical Stage I Non-Small Cell Lung Cancer

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) for clinical stage I non-small cell lung cancer (NSCLC) has been widely used as a less invasive surgical procedure, but the resection method is still controversial. We retrospectively compared the surgical outcomes of lobectomy, segmentectomy and wedge resection. Patients and Methods: A total of 411 patients with clinical stage I NSCLC who underwent VATS (218 males and 193 females, aged 69.3 years; 345 adenocarcinomas, 57 squamous cell carcinomas, and 9 others) were investigated. The surgical procedure was lobectomy in 289, segmentectomy in 38, and wedge resection in 84. Surgical outcomes were compared among these 3 groups. Results: Demographic characteristics showed that the rate of elderly and male patients was higher in the wedge resection group. The 5-year survival rates for the lobectomy, segmentectomy, and wedge resection groups were 82.1, 87.2, and 55.4 %, respectively. In the wedge resection group, the 5-year survival rate was 83.3 % in patients undergoing intentional low-risk operations for small tumors with ground glass opacity, and 41.1 % in those undergoing conservative high-risk operations because of comorbidities. Using Cox's proportional multivariate analysis and sex differences, histology, and tumor size as co-influential factors, the surgical procedure was found to be a significantly poor prognostic factor, and the hazard ratio of wedge resection relative to lobectomy was 4.30. Conclusion: The outcomes of VATS lobectomy and segmentectomy procedures for clinical stage I NSCLC were equivalent, while the outcome for VATS wedge resection was inferior. VATS wedge resection for clinical stage I NSCLC should be carefully indicated and requires adequate patient selection.

Key words

thoracic surgery - cardiovascular surgery - coronary bypass surgery

References

• 1 Ginsberg R J, Rubinstein L V. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer.  Ann Thorac Surg. 1995;  60 612-622
• 2 Keenan R J, Landreneau R J, Maley jr R H et al. Segmental resection spares pulmonary function in patients with stage I lung cancer.  Ann Thorac Surg. 2007;  84 926-933
• 3 Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer. A multicenter study.  J Thorac Cardiovasc Surg. 2006;  132 769-775
• 4 Kodama K, Higashiyama M, Takami K et al. Treatment strategy for patients with small peripheral lung lesion(s): intermediate-term results of prospective study.  Eur J Cardiothorac Surg. 2009;  34 1068-1074
• 5 Sienel W, Dango S, Kirschbaum A et al. Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections.  Eur J Cardiothorac Surg. 2008;  33 728-734
• 6 Frores R M, Park B J, Dycoco J et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer.  J Thorac Cardiovasc Surg. 2009;  138 11-18
• 7 Schuchert M J, Pettiford B L, Pennathur A et al. Anatomic segmentectomy for stage I non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach.  J Thorac Cardiovasc Surg. 2009;  138 1318-1325
• 8 Yamashita S, Chujo M, Kawano Y et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage I non-small cell lung cancer.  J Surg Res. 2009;  13 1-6
• 9 Shapiro M, Weiser T S, Wisnivesky J P, Chin C, Arustamyan M, Swanson S J. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer.  J Thorac Cardiovasc Surg. 2009;  137 1388-1393
• 10 Watanabe A, Ohori S, Nakashima S et al. Feasibility of video-assisted thoracic surgery segmentectomy for selected peripheral lung carcinoma.  Eur J Cardiothorac Surg. 2009;  35 775-780
• 11 D'Amico T A. Thoracoscopic segmentectomy. Technical considerations and outcomes.  Ann Thorac Surg. 2008;  85 16-18
• 12 Sawabata N, Ohta M, Matsumura A et al. Optimal distance of malignant negative margin in excision of non-small cell lung cancer: a multicenter prospective study.  Ann Thorac Surg. 2004;  77 415-420
• 13 Higashiyama M, Kodama K, Takami K, Higaki N, Nakayama T, Yokouchi H. Intraoperative lavage cytologic analysis of surgical margins in patients undergoing limited surgery for lung cancer.  J Thorac Cardiovasc Surg. 2003;  125 101-107
• 14 Lagerwaard F J, Haasbeek C J, Smit E F, Slotman B J, Senan S. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer.  Int J Radiat Oncol Biol Phys. 2008;  70 685-692
• 15 Beland M D, Wasser E J, Mayo-Smith W W, Dupuy D E. Primary non-small cell lung cancer: review of frequency, location, and time of recurrence after radiofrequency ablation.  Radiotherapy. 2010;  254 301-307