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Tane S, Okami J, Maniwa Y, Shintani Y, Ito H, Ohtsuka T, Toyooka S, Mori T, Watanabe SI, Chida M, Endo S, Nakanishi R, Kadokura M, Suzuki H, Miyaoka E, Yoshino I, Date H. Clinical outcomes of left upper segmentectomy vs. lobectomy for early non-small-cell lung cancer: a nationwide database study in Japan. Surg Today 2024:10.1007/s00595-024-02844-8. [PMID: 38635057 DOI: 10.1007/s00595-024-02844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/09/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Given that left upper lobe and right upper and middle lobes share a similar anatomy, segmentectomy, such as upper division and lingulectomy, should yield identical oncological clearance to left upper lobectomy. We compared the prognosis of segmentectomy with that of lobectomy for early stage non-small-cell lung cancer (NSCLC) in the left upper lobe. METHODS We retrospectively examined 2115 patients who underwent segmentectomy or lobectomy for c-stage I (TNM 8th edition) NSCLC in the left upper lobe in 2010. We compared the oncological outcomes of segmentectomy (n = 483) and lobectomy (n = 483) using a propensity score matching analysis. RESULTS The 5-year recurrence-free and overall survival rates in the segmentectomy and lobectomy groups were comparable, irrespective of c-stage IA or IB. Subset analyses according to radiological tumor findings showed that segmentectomy yielded oncological outcomes comparable to those of lobectomy for non-pure solid tumors. In cases where the solid tumor exceeded 20 mm, segmentectomy showed a recurrence-free survival inferior to that of lobectomy (p = 0.028), despite an equivalent overall survival (p = 0.38). CONCLUSION Segmentectomy may be an acceptable alternative to lobectomy with regard to the overall survival of patients with c-stage I NSCLC in the left upper lobe.
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Affiliation(s)
- Shinya Tane
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Ohtsuka
- Division of General Thoracic Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takeshi Mori
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Japan
| | - Shunsuke Endo
- Department of Thoracic Surgery, Jichi Ika University Saitama Medical Center, Saitama, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsutaka Kadokura
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Tokyo University of Science, Tokyo, Japan
| | - Ichiro Yoshino
- Department of Thoracic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Bayfield NGR, Bibo L, Wang E, Edelman J. Left Upper Lobe Multi-Segmentectomy Vs Lobectomy for Early-Stage Lung Cancer: A Meta-Analysis. Heart Lung Circ 2023; 32:596-603. [PMID: 36959019 DOI: 10.1016/j.hlc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION The left upper lobe (LUL) has unique hilar anatomy, and LUL multi-segmentectomy (apical trisegmentectomy and lingulectomy) may result in different outcomes than both single anatomical segmentectomy and left upper lobectomy in the management of early-stage primary lung cancer; however no meta-analyses have been performed. The aim of this meta-analysis is to determine if LUL multi-segmentectomy is non-inferior to left upper lobectomy for long-term survival outcomes, or superior for in-hospital outcomes. METHODS Electronic databases searches were performed on PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes in LUL multi-segmentectomy vs left upper lobectomy in early-stage lung cancer (clinical stage T2 N0 or less). Long-term postoperative overall and disease-free survival were assessed via reconstruction of Kaplan-Meier survival curves. In-hospital complications and length of stay, as well as long term recurrence were analysed via random effects models. RESULTS Five relevant studies were identified, including 1,196 patients. Overall survival did not differ at 5 years (multi-segmentectomy 92.6% vs lobectomy 89.3%, P=0.188), but patients undergoing LUL multi-segmentectomy had better disease-free survival at 5 years (93.1% vs 88.4%, P=0.041). Patients undergoing LUL multi-segmentectomy had a shorter mean length of hospital stay (mean difference -0.26 days, 95% CI; -0.39 to 0.14, P<0.01, I2=0.00%). There was no difference in combined in-hospital complications (P=0.14), local recurrence (P=0.35), distant recurrence (P=0.23), or overall recurrence (P=0.39). CONCLUSION LUL multi-segmentectomy is associated with reduced hospital length of stay, but no difference in long-term overall survival compared with left upper lobectomy in the management of early-stage primary lung cancer.
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Affiliation(s)
- Nicholas G R Bayfield
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia.
| | - Liam Bibo
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - Edward Wang
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
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Nishikubo M, Tane S, Kimura K, Shimizu N, Kitamura Y, Nishio W. Comparison of oncological outcomes between trisegmentectomy and lobectomy for non-small cell lung cancer in the left upper division. J Thorac Dis 2022; 14:4614-4623. [PMID: 36647461 PMCID: PMC9840034 DOI: 10.21037/jtd-22-950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The left upper lobe is one of the largest lobes in the lungs and is divided into two anatomical units: the upper division (segments 1+2 and segment 3) and lingula (segments 4 and 5). This anatomical classification is similar to that used for the right upper and middle lobes. Although bilobectomy is not recommended for right upper or middle lobe tumors close to the interlobar plane, lobectomy is often performed for tumors located close to the intersegmental plane in the left upper division. To aid in establishing trisegmentectomy as a standard treatment for clinical N0 non-small cell lung cancer (NSCLC) in the left upper lobe, we aimed to re-assess its feasibility based on oncological outcomes according to tumor location. METHODS We retrospectively analyzed the data of patients with clinical N0 NSCLC in the left upper division who underwent left upper lobectomy or trisegmentectomy between April 2006 and December 2020. After propensity score matching, oncological outcomes were compared between the trisegmentectomy and lobectomy groups. To verify whether trisegmentectomy was indicated regardless of tumor distance from the intersegmental plane, we compared the recurrence-free survival (RFS) rates following trisegmentectomy between patients with tumors ≤20 and >20 mm from the intersegmental plane. RESULTS After propensity score matching, 46 patients were included in each group. There was no significant difference in the 5-year RFS rate between the lobectomy and trisegmentectomy groups (75.5% vs. 84.0%, P=0.41). In the trisegmentectomy cohort, the 5-year RFS rate did not significantly differ according to tumor distance from the intersegmental plane (≤20 or >20 mm) measured using three-dimensional computed tomography (79.4% vs. 81.2%, P=0.69). Multivariate analysis indicated that tumor distance from the intersegmental plane was not a significant predictor of RFS (hazard ratio: 1.75, 95% confidence interval: 0.52-5.91, P=0.37). CONCLUSIONS Our analysis suggests that oncological outcomes (i.e., RFS rates) following trisegmentectomy for clinical N0 NSCLC in the left upper division are not significantly inferior to those following lobectomy, even if the tumor is located close to the intersegmental plane.
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Affiliation(s)
| | | | - Kenji Kimura
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Nahoko Shimizu
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | | | - Wataru Nishio
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
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Zhou B, Xu X, Dai J, Guo Y, Jin K, Zhu Y, Wang H, Jiang G. Propensity-matched Comparison of VATS Left Upper Tri-segmentectomy and Lobectomy. Ann Thorac Surg 2021; 114:1007-1014. [PMID: 34428431 DOI: 10.1016/j.athoracsur.2021.07.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/22/2021] [Accepted: 07/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study aims to investigate the oncological outcomes of video-assisted thoracoscopic (VATS) left upper tri-segmentectomy (LTS) versus left upper lobectomy (LUL) for patients presenting with stage I non-small-cell lung cancer (NSCLC). METHODS A retrospective analysis identified 1543 consecutive patients presenting to Shanghai Pulmonary Hospital with NSCLC for VATS-LTS or LUL from 2013-2017. After propensity-score matching for patient demographics and tumor characteristics, 273 pairs were identified. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the Log-rank test. RESULTS The median follow-up time was 51.5 months. There were no significant differences in operative duration (2.11±0.64 versus 2.49±5.96 h, p=0.30), total blood loss (106.19±170.83 versus 97.07±149.34 mL, p=0.51) and operation complications (10% versus 8%, p=0.37) between LUL and LTS. Patients undergoing LUL had longer postoperative hospital stay (5.55±3.00 versus 4.87±2.33 days, p=0.003), greater tumor margin distance (3.3±1.2 versus 3.1±0.9 cm, p<.001) and greater number of lymph nodes harvested (8.0±3.2 versus 6.8±3.3, p<.001) than LTS, but the margin/tumor ratio was not statistically different (2.5±1.6 versus 2.3±1.1, p=0.11). Median DFS (49.5 versus 54.3 months, p=0.77) and OS (49.5 versus 55.0 months, p=0.88) were not significantly different between patients undergoing LTS and LUL, and similar outcomes were noted across subgroups of patients stratified by tumor stages, pathological type, and radiographic manifestations. CONCLUSIONS VATS-LTS and LUL had comparable oncological outcomes for stage I NSCLC, regardless of tumor pathological types and radiological findings, as long as negative margins were confirmed.
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Affiliation(s)
- Bin Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Xiaoxiong Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Yanhua Guo
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Kaiqi Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - HaiFeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China.
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Tane S, Nishio W, Fujibayashi Y, Nishikubo M, Nishioka Y, Ogawa H, Kitamura Y, Takenaka D, Yoshimura M. Thoracoscopic left S1 + 2 segmentectomy as a good resolution for preserving pulmonary function. Interact Cardiovasc Thorac Surg 2020; 31:331-338. [PMID: 32747959 DOI: 10.1093/icvts/ivaa105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Segmentectomies such as S1 + 2, S1 + 2+3 and S4 + 5 segmentectomy are used to treat patients with non-small-cell lung cancer (NSCLC) in the left upper lobe. However, the preservable lung volume and changes after such segmentectomies remain unknown. We compared the residual pulmonary function after thoracoscopic segmentectomy or lobectomy in the left upper lobe and examined the efficacy of S1 + 2 segmentectomy regarding postoperative pulmonary function. METHODS Patients with left upper lobe NSCLC who underwent thoracoscopic segmentectomy or lobectomy were included. Spirometry and computed tomography were performed before and 6 months after resection, and the ipsilateral preserved lobe volume was calculated using 3-dimensional computer tomography. The percentage of postoperative/preoperative forced expiratory volume in 1 s and actual/predicted regional forced expiratory volume in 1 s (preservation rate) in the residual lobe were compared. RESULTS Eighty-eight patients underwent lobectomy and 70 patients underwent segmentectomy (23 S1 + 2, 35 S1 + 2+3 and 12 S4 + 5 segmentectomies). The percentage of postoperative/preoperative forced expiratory volume in 1 s was 97 in S1 + 2, 82 in S1 + 2+3, 86 in S4 + 5 segmentectomy and 73 in left upper lobectomy, indicating that segmentectomy could be a meaningful approach to preserve pulmonary function. The preservation rate was 83% in S1 + 2 and 62% in S1 + 2+3 segmentectomy and was significantly higher in S1 + 2 than in S1 + 2+3 segmentectomy (P < 0.001). CONCLUSIONS Postoperative pulmonary function and the preservable lung volume of the residual lobe after thoracoscopic S1 + 2 segmentectomy were well-preserved among other segmentectomies and lobectomy. Thoracoscopic S1 + 2 segmentectomy is a good alternative for preserving postoperative function.
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Affiliation(s)
- Shinya Tane
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Wataru Nishio
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | | | - Yuki Nishioka
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Hiroyuki Ogawa
- Division of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Daisuke Takenaka
- Division of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan
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Aprile V, Bertoglio P, Dini P, Palmiero G, Mussi A, Ambrogi MC, Lucchi M. Is left upper lobectomy always worthwhile for early stage lung cancer? A comparison between left upper lobectomy, trisegmentectomy, and lingulectomy. J Surg Oncol 2017; 117:618-624. [PMID: 29049856 DOI: 10.1002/jso.24884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/20/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Lobectomy is the gold standard treatment for resectable Non-Small Cell Lung Cancer (NSCLC). We compared oncological outcomes of patients undergoing a "multi-segmentectomy" (trisegmentectomy or lingulectomy) and left upper lobectomy for early stage (T1-2, N0) NSCLC of the left upper lobe. METHODS We retrospectively analyzed all patients with pathological early stage (T1-T2 N0) NSCLC located in left upper lobe who underwent a lobectomy, a trisegmentectomy, or a lingulectomy between 2006 and 2013, focusing on surgical and oncological outcomes. RESULTS Among 159 patients, 105 patients underwent a lobectomy and 54 patients a multi-segmentectomy (33 lingulectomy and 21 trisegmentectomy). Actuarial mean Overall Survival was 87 months (95%CI 79-95) and 89 months (95%CI 76-101) for lobectomies and multi-segmentectomies, respectively (P-value: 0.895), while actuarial mean Disease Free Interval was 91 months (95%CI 82-100) and 96 months (95%CI 84-108) respectively (P-value: 0.565). We did not observe any difference in terms of local recurrence rate between the two groups (P = 0.337). CONCLUSIONS Lingulectomy and trisegmentectomy lead to similar oncological outcomes compared to left upper lobectomy for T1 and T2 N0 NSCLC, and they could be used as an alternative to lobectomy even in patients with a good pulmonary function.
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Affiliation(s)
- Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100, Pisa, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, Sacro Cuore Don Calabria Research Hospital and Cancer Care Centre, Negrar, Verona, Italy
| | - Paolo Dini
- Division of Thoracic Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2 56100, Pisa, Italy
| | - Gerardo Palmiero
- Division of Thoracic Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2 56100, Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100, Pisa, Italy
| | - Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100, Pisa, Italy
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Witte B, Stenz C, Vahl CF, Huertgen M. Comparative intention-to-treat analysis of the video-assisted thoracoscopic surgery approach to pulmonary segmentectomy for lung carcinoma. Interact Cardiovasc Thorac Surg 2015; 21:276-83. [DOI: 10.1093/icvts/ivv143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/08/2015] [Indexed: 11/12/2022] Open
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