Segmentectomy as a safe and equally effective surgical option under complete video-assisted thoracic surgery for patients of stage I non-small cell lung cancer

Xiaojing Zhao, Liqiang Qian, Qingquan Luo, Jia Huang, Xiaojing Zhao, Liqiang Qian, Qingquan Luo, Jia Huang

Abstract

Background: While video-assisted thoracic surgery lobectomy has been widely accepted for the treatment of non-small cell lung cancer, the debate over video-assisted thoracic surgery segmentectomy still remains. This study compared the clinical outcomes using the two procedures for stage I non-small cell lung cancer patients.

Methods: Retrospective review was conducted on patients who underwent video-assisted thoracic surgery segmentectomy or lobectomy for clinical stage I non-small cell lung cancer at Shanghai Chest Hospital between November 2009 and May 2012. Video-assisted thoracic surgery segmentectomy was performed on 36 patients and video-assisted thoracic surgery lobectomy on 138 patients. Comparisons between the 2 groups were performed in patient demographic and clinical characteristics, intraoperative parameters and oncology outcomes.

Results: Mean volume of chest tube drainage after operation was smaller for segmentectomy than for lobectomy (1021 ml vs. 1328 ml, P=0.036). Other parameters analysis including blood loss, operation time, chest tube duration and length of hospital stay favors the segmentectomy group numerically without significance. There was no significant difference in distributions in both intra and post operative complications. There was one peri-operative mortality from segmentectomy group and all other patients are alive with a median follow up of 327 days. There were 1 (2.8%) locoregional recurrence after segmentectomy and 6 recurrences (4.4%) after lobectomy (P=1.00). Multivariate survival analysis revealed no significant difference in recurrence-free survivals between the two groups. Two patients successfully underwent bilateral segmentectomies and are free of disease.

Conclusions: For patients with stage I non-small cell lung cancer, video-assisted thoracic surgery segmentectomy offers a safe and equally effective option and can be applied to complicated operation such as bilateral segmentectomy.

Figures

Figure 1
Figure 1
Standard preoperative evaluation and algorithm of assessments and procedures.
Figure 2
Figure 2
Recurrence-free survival.

References

    1. Yamashita S, Chujo M, Kawano Y. 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. 2011;166:46. doi: 10.1016/j.jss.2009.04.006.
    1. Jensik RJ, Faber LP, Milloy FJ. Segmental resection for lung cancer. A fifteen-year experience. J Thorac Cardiovasc Surg. 1973;66:563.
    1. Schuchert MJ, Pettiford BL, Keeley S. Anatomic segmentectomy in the treatment of stage I non–small cell lung cancer. Ann Thorac Surg. 2007;84:926. doi: 10.1016/j.athoracsur.2007.05.007.
    1. Okumura M, Goto M, Ideguchi K. Factors associated with outcome of segmentectomy for non–small cell lung cancer: longterm follow-up study at a single institution in Japan. Lung Cancer. 2007;58:231. doi: 10.1016/j.lungcan.2007.06.014.
    1. El-Sherif A, Gooding WE, Santos R. Outcomes of sublobar resection versus lobectomy for stage I non–small cell lung cancer: a 13-year analysis. Ann Thorac Surg. 2006;82:408. doi: 10.1016/j.athoracsur.2006.02.029.
    1. Okada M, Yoshikawa K, Hatta T. Is segmentectomy with lymph node assessment an alternative to lobectomy for non–small cell lung cancer of 2 cm or smaller? Ann Thorac Surg. 2001;71:956. doi: 10.1016/S0003-4975(00)02223-2.
    1. Martin-Ucar AE, Nakas A, Pilling JE. A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in highrisk patients. Eur J Cardiothorac Surg. 2005;27:675. doi: 10.1016/j.ejcts.2005.01.006.
    1. Okada M, Koike T, Higashiyama M. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132:769. doi: 10.1016/j.jtcvs.2006.02.063.
    1. Onaitis MW, Petersen RP, Balderson SS. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg. 2006;244:420.
    1. Nagahiro I, Andou A, Aoe M. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg. 2001;72:362. doi: 10.1016/S0003-4975(01)02804-1.
    1. Nicastri DG, Wisnivesky JP, Litle VR. Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg. 2008;135:642. doi: 10.1016/j.jtcvs.2007.09.014.
    1. Ohtsuka T, Nomori H, Horio H. Is major pulmonary resection by video-assisted thoracic surgery an adequate procedure in clinical stage I lung cancer? Chest. 2004;125:1742. doi: 10.1378/chest.125.5.1742.
    1. Walker WS, Codispoti M, Soon SY. Longterm outcomes following VATS lobectomy for non–small cell bronchogenic carcinoma. Eur J Cardiothorac Surg. 2003;23:397. doi: 10.1016/s1010-7940(02)00814-x.
    1. Petersen RP, Pham D, Burfeind WR. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg. 2007;83:1245. doi: 10.1016/j.athoracsur.2006.12.029.
    1. Shiraishi T, Shirakusa T, Iwasaki A. Video-assisted thoracoscopic surgery (VATS) segmentectomy for small peripheral lung cancer tumors: intermediate results. Surg Endosc. 2004;18:1657.
    1. Li WW, Lee TW, Lam SS. Quality of life following lung cancer resection: video-assisted thoracic surgery vs thoracotomy. Chest. 2002;122:584. doi: 10.1378/chest.122.2.584.
    1. Warren WH, Faber LP. Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg. 1994;107:108.
    1. Shapiro M, Weiser TS, Wisnivesky JP. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J Thorac Cardiovasc Surg. 2009;137(6):1388. doi: 10.1016/j.jtcvs.2009.02.009.
    1. Dendo S, Kanazawa S, Ando A. Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. Radiology. 2002 Nov;225(2):511. doi: 10.1148/radiol.2252011025.
    1. Mahtabifard A, DeArmond DT, Fuller CB. Video-assisted thoracoscopic surgery lobectomy for stage I lung cancer. Thorac Surg Clin. 2007;17(2):223. doi: 10.1016/j.thorsurg.2007.03.019.
    1. Liu L, Che G, Pu Q. A new concept of endoscopic lung cancer resection: single-direction thoracoscopic lobectomy. Surg Oncol. 2010;19(2):e71. doi: 10.1016/j.suronc.2009.04.005.
    1. Wang J, Li Y, Liu J. Video-assisted thoracoscopic lobectomy for early non-small cell lung cancer. Chin J Thorac Cardiovascu Surg. 2008;24(3):147.
    1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non–small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615. doi: 10.1016/0003-4975(95)00537-U.
    1. Jones DR, Stiles BM, Denlinger CE. Pulmonary segmentectomy: results and complications. Ann Thorac Surg. 2003;76:343. doi: 10.1016/S0003-4975(03)00437-5.
    1. Okada M, Nishio W, Sakamoto T. 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. doi: 10.1016/j.jtcvs.2004.04.030.
    1. Bando T, Yamagihara K, Ohtake Y. A new method of segmental resection for primary lung cancer: intermediate results. Eur J Cardiothorac Surg. 2002;21:894. doi: 10.1016/S1010-7940(02)00122-7.
    1. McKenna RJ Jr, Houck WV. New approaches to the minimally invasive treatment of lung cancer. Curr Opin Pulm Med. 2005;11:282. doi: 10.1097/01.mcp.0000166589.08880.44.
    1. Ettinger DS, Akerley W, Borghaei H. Non-small cell lung Cancer. J Natl Compr Canc Netw. 2012;10(10):1236.
    1. Swanson SJ. Segmentectomy for lung cancer. Semin Thorac Cardiovasc Surg. 2010;22(3):244. doi: 10.1053/j.semtcvs.2010.10.014.
    1. El-Sherif A, Fernando HC, Santos R. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol. 2007;14(8):2400. doi: 10.1245/s10434-007-9421-9.
    1. Atkins BZ, Harpole DH Jr, Mangum JH. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. Ann Thorac Surg. 2007;84:1107. doi: 10.1016/j.athoracsur.2007.05.013.
    1. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81:421. doi: 10.1016/j.athoracsur.2005.07.078.
    1. Sienel W, Stremmel C, Kirschbaum A. 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. 2007;31(3):522. doi: 10.1016/j.ejcts.2006.12.018.
    1. Martini N, Bains MS, Burt ME. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg. 1995;109:120. doi: 10.1016/S0022-5223(95)70427-2.
    1. Mun M, Kohno T. Efficacy of thoracoscopic resection for multifocal bronchioloalveolar carcinoma showing pure ground-glass opacities of 20 mm or less in diameter. J Thorac Cardiovasc Surg. 2007;134(4):877. doi: 10.1016/j.jtcvs.2007.06.010.
    1. Mun M, Kohno T. Single-stage surgical treatment of synchronous bilateral multiple lung cancers. Ann Thorac Surg. 2007;83:1146. doi: 10.1016/j.athoracsur.2006.10.037.

Source: PubMed

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