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Xu S, Su C. Segmentectomy for NSCLC: a better alternative? THE LANCET. RESPIRATORY MEDICINE 2023:S2213-2600(23)00076-0. [PMID: 36893781 DOI: 10.1016/s2213-2600(23)00076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Song Xu
- Department of Lung Cancer Surgery and Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Chunxia Su
- Department of Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
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Jung Y, Longo C, Tompa E. Longitudinal Assessment of Labor Market Earnings Among Patients Diagnosed With Cancer in Canada. JAMA Netw Open 2022; 5:e2245717. [PMID: 36547984 PMCID: PMC9857413 DOI: 10.1001/jamanetworkopen.2022.45717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE To our knowledge, there have been no studies that estimated the short-, mid-, and long-term effects on cancer survivors' labor market earnings using administrative data. OBJECTIVE To estimate the change in labor market earnings due to cancer diagnosis stratified by cancer type and age category. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used a retrospective analysis of Statistics Canada's administrative linkage file, which includes microdata from the 1991 Census, the Canadian Cancer Registry, mortality records, and personal income tax files. Participants included patients newly diagnosed with cancer from 1992 to 2008. All statistical analyses were finished on September 30, 2020. EXPOSURES Cancer diagnosis using the International Classification of Diseases, Ninth Revision, and the International Classification of Diseases, Tenth Revision. MAIN OUTCOMES AND MEASURES Annual and percent change in labor market earnings. The empirical strategy used a combination of the Mahalanobis distance and propensity score matching method and the difference-in-difference regression method to select a control group similar to the cancer survivors in this study and assess the association of the cancer diagnosis with labor market earnings, respectively. RESULTS A total of 59 532 patients with cancer and 243 446 patients without cancer were included in the main analysis. The mean (SD) age was similar between the matched treatment and control cohort (49.70 [8.1] years vs 49.68 [7.2] years), as was the proportion of females (0.49 vs 0.49), and the individual reported income ($37 937 [$18 645] vs $37 396 [$16 876]). The results showed the negative associations of cancer with labor market earnings. Additionally, the severity of the cancer was associated with labor market earnings, where cancer survivors with a severe type of cancer in terms of the 5-year survival rate are shown to have a larger and more persistent earnings difference compared with the control group. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that labor market earnings losses are associated with a cancer diagnosis. A better understanding of the loss of labor market earnings following cancer diagnosis and by cancer type can play an important role in starting a dialogue in future policy initiatives to mitigate the financial burden faced by cancer survivors.
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Affiliation(s)
- Young Jung
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Klick Health, Toronto, Ontario, Canada
| | - Christopher Longo
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Emile Tompa
- Department of Economic, McMaster University, Hamilton, Ontario, Canada
- Institute for Work and Health, Toronto, Ontario, Canada
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Qi Y, Qiu Z, Zhang C, Fu R, Yang X, Chu X, Chen Z, Yang X, Wu Y, Zhong W. Sublobectomy for stage IA1-2 invasive lung adenocarcinoma with consolidation tumor ratio ≤ 0.25. Thorac Cancer 2022; 13:3174-3182. [PMID: 36208139 PMCID: PMC9663678 DOI: 10.1111/1759-7714.14672] [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: 07/20/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sublobectomy for early-stage non-small cell lung cancer (NSCLC) remains a matter of debate. This study aimed to discuss the feasibility of sublobectomy in patients with pathological-stage IA1-2 confirmed as pathologically invasive but radiologically noninvasive adenocarcinoma. METHODS From 2011 to 2019, we screened clinical stage IA1-IA2 lung cancer patients who underwent surgery at the Guangdong Provincial People's Hospital (GDPH). Inclusion criteria were maximum tumor diameter of 2.0 cm or less, consolidation tumor ratio (CTR) ≤ 0.25, and pathologically confirmed invasive adenocarcinoma. Sublobectomy (segmentectomy and wedge resection) and lobectomy groups were created, and propensity scores were computed. The primary endpoints were lung cancer-specific overall survival (LCSS) and LCS- relapse-free survival (LCS-RFS) after adjusting propensity scores. RESULTS A total of 1731 patients were screened, and 100 patients were enrolled. The lobectomy group had 51 patients and the limited resection group had 49. No cases relapsed, and two patients died from nontumor causes. For the entire cohort, the 5-year LCSS and 5-year LCS-RFS were 100% in the lobectomy and limited resection groups. When propensity scores matched, there were no differences in LCSS and LCS-RFS between the two groups (LCSS:100%, LCS-RFS 100% in lobectomy and limited resection, respectively). DISCUSSION Sublobectomy may be curative for pathologically invasive but radiologically noninvasive adenocarcinoma at pathological stage IA1-2.
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Affiliation(s)
- Yi‐Fan Qi
- School of MedicineSouth China University of TechnologyGuangzhouChina,Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Zhen‐Bin Qiu
- School of MedicineSouth China University of TechnologyGuangzhouChina,Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Chao Zhang
- School of MedicineSouth China University of TechnologyGuangzhouChina,Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Rui Fu
- School of MedicineSouth China University of TechnologyGuangzhouChina,Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Xiong‐Wen Yang
- School of MedicineSouth China University of TechnologyGuangzhouChina,Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Xiang‐Peng Chu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Zi‐Hao Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina,The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Xue‐Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Yi‐Long Wu
- School of MedicineSouth China University of TechnologyGuangzhouChina,Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Wen‐Zhao Zhong
- School of MedicineSouth China University of TechnologyGuangzhouChina,Guangdong Lung Cancer Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Guangdong Provincial Key Laboratory of Translational Medicine in Lung CancerGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
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Bade BC, Blasberg JD, Mase VJ, Kumbasar U, Li AX, Park HS, Decker RH, Madoff DC, Brandt WS, Woodard GA, Detterbeck FC. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors. J Thorac Dis 2022; 14:2387-2411. [PMID: 35813753 PMCID: PMC9264070 DOI: 10.21037/jtd-21-1825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn't been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined. Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors <1 cm are not a reliably favorable group. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
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Affiliation(s)
- Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Chen Y, Jiang C, Kang W, Gong J, Luo D, You S, Cheng Z, Luo Y, Wu K. Development and validation of a CT-based nomogram to predict spread through air space (STAS) in peripheral stage IA lung adenocarcinoma. Jpn J Radiol 2022; 40:586-594. [DOI: 10.1007/s11604-021-01240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
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Liao G, Huang L, Wu S, Zhang P, Xie D, Yao L, Zhang Z, Yao S, Shanshan L, Wang S, Wang G, Wing-Chi Chan L, Zhou H. Preoperative CT-based peritumoral and tumoral radiomic features prediction for tumor spread through air spaces in clinical stage I lung adenocarcinoma. Lung Cancer 2022; 163:87-95. [PMID: 34942493 DOI: 10.1016/j.lungcan.2021.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/30/2021] [Accepted: 11/25/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aims to develop and evaluate preoperative CT-based peritumoral and tumoral radiomic features to predict tumor spread through air space (STAS) status in clinical stage I lung adenocarcinoma (LUAD). MATERIALS AND METHODS From June 2018 to December 2019, a retrospective diagnostic investigation was done. Patients with pathologically confirmed STAS status (N = 256) were eventually enrolled. The development cohort consisted of 191 patients (74.6%) chosen randomly in a 7:3 ratio, whereas the validation group consisted of 65 patients (25.4%). The performance of models was assessed using receiver operating characteristic analysis, accuracy, sensitivity, specificity, negative predictive values, and positive predictive values. RESULTS The STAS positive status was found in 85 (33.2%) of the 256 patients (female: 53.2%; median [IQR] age: 62.0, [53.0-79.0] years), while the STAS negative status was found in 171 patients (66.8%) (female:50.6%; median [IQR] age: 62.0, [53.0-87.0] years). The combined TRS and PRS-15 mm model had an AUC of 0.854 (95% CI, 0.799-0.909) in the development cohort and 0.870 (95% CI, 0.781-0.958) in the validation cohort, indicating that the tumor radiomic signature (TRS) model and different peritumoral radiomic signature (PRS) models were used to build the optimal gross radiomic signature (GRS) model. The radiomic nomogram achieves superior discriminatory performance than GRS and clinical and radiological signatures (CRS), with an AUC of 0.871 (95% CI, 0.820-0.922) in the development cohort and AUC of 0.869 (95% CI, 0.776-0.961) in the validation cohort. Based on the Akaike information criterion (AIC) and decision curve analysis (DCA), the radiomic nomogram provided greater clinical predictive capacity than clinical or any radiomic signatures alone. CONCLUSION In conclusion, we discovered that peritumoral characteristics were substantially related to STAS status. This study revealed the unit of radiomic signature and clinical signatures may have a better performance in STAS status.
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Affiliation(s)
- Guoqing Liao
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Luyu Huang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Shaowei Wu
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Peirong Zhang
- Department of Thoracic Surgery, Maoming People's Hospital, Maoming, China
| | - Daipeng Xie
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lintong Yao
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhengjie Zhang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Su Yao
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lyu Shanshan
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siyun Wang
- Department of PET Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guangyi Wang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lawrence Wing-Chi Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Thoracic Surgery, Jiangxi Lung Cancer Institute, Jiangxi Cancer Hospital, Nanchang, China
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Song SH, Lee HS, Moon DH, Lee S. Percutaneous Electromagnetic Transthoracic Nodule Localization for Ground Glass Nodules. J Chest Surg 2021; 54:494-499. [PMID: 34857672 PMCID: PMC8646072 DOI: 10.5090/jcs.21.035] [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: 04/26/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background A recent increase in the incidental detection of ground glass nodules (GGNs) has created a need for improved diagnostic accuracy in screening for malignancies. However, surgical diagnosis remains challenging, especially via video-assisted thoracoscopic surgery (VATS). Herein, we present the efficacy of a novel electrical navigation system for perioperative percutaneous transthoracic nodule localization. Methods Eighteen patients with GGNs who underwent electromagnetic navigated percutaneous transthoracic needle localization (ETTNL), followed by 1-stage diagnostic wedge resections via VATS between January and December 2020, were included in the analysis. Data on patient characteristics, nodules, procedures, and pathological diagnoses were collected and retrospectively reviewed. Results Of the 18 nodules, 17 were successfully localized. Nine nodules were pure GGNs, and the remaining 9 were part-solid GGNs. The median nodule size was 9.0 mm (range, 4.0-20.0 mm); and the median depth from the visceral pleura was 5.2 mm (range, 0.0-14.4 mm). The median procedure time was 10 minutes (range, 7-20 minutes). The final pathologic results showed benign lesions in 3 cases and malignant lesions in 15 cases. Conclusion Perioperative ETTNL appears to be an effective method for the localization of GGNs, providing guidance for a 1-stage VATS procedure.
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Affiliation(s)
- Seung Hwan Song
- Department of Thoracic and Cardiovascular Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyun Soo Lee
- Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Duk Hwan Moon
- Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungsoo Lee
- Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kennedy GT, Azari FS, Bernstein E, Desphande C, Din A, Marfatia I, Kucharczuk JC, Delikatny EJ, Low PS, Singhal S. 3D Specimen Mapping Expedites Frozen Section Diagnosis of Non-Palpable Ground Glass Opacities. Ann Thorac Surg 2021; 114:2115-2123. [PMID: 34774493 PMCID: PMC9188686 DOI: 10.1016/j.athoracsur.2021.09.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/07/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary ground glass opacities (GGOs) are early-stage adenocarcinoma spectrum lesions that are not easily palpable. Challenges in localizing GGOs during intraoperative pathology can lead to imprecise diagnoses and additional time under anesthesia. To improve localization of GGOs during frozen section diagnosis, we evaluated a novel technique, three-dimensional near-infrared specimen mapping (3D-NSM). METHODS Fifty-five patients with a cT1 GGO were enrolled and received a fluorescent tracer preoperatively. After resection, specimens were inspected to identify lesions. Palpable and non-palpable nodules underwent 3D-NSM and the area of highest fluorescence was marked with a suture. Time for 3D-NSM, time for frozen section diagnosis, and number of tissue sections examined were recorded. To compare 3D-NSM to standard-of-care techniques, a control cohort of twenty subjects with identical inclusion criteria were enrolled. Specimens did not undergo 3D-NSM and were sent directly to pathology. RESULTS 3D-NSM localized 54/55 lesions with one false negative. All 41 palpable lesions were identified by 3D-NSM. Thirteen of 14 non-palpable lesions (92.8%) were located by 3D-NSM. Time to diagnosis for the 3D-NSM cohort was 23.5 minutes, compared to 26.0 minutes in the control cohort (p=0.04). 3D-NSM did not affect time to diagnosis of palpable lesions (23.2 min vs. 21.4 minutes, p=0.10). 3D-NSM significantly reduced time to diagnosis for non-palpable lesions (t=23.3 min vs. 34.4 minutes, p<0.0001). 3D-NSM also reduced the number of tissue sections analyzed in non-palpable lesions (4.50 vs. 11.00, p<0.0001). CONCLUSIONS 3D-NSM accurately localizes GGOs and expedites intraoperative diagnosis by reducing the number of tissue sections analyzed for non-palpable GGOs.
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Affiliation(s)
- Gregory T Kennedy
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Feredun S Azari
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Elizabeth Bernstein
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Charuhas Desphande
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Azra Din
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Isvita Marfatia
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - John C Kucharczuk
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Edward J Delikatny
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, IN
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
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Wu L, Zhao W, Chen T, Yang Y. Surgical choice for patients with stage I non-small-cell lung cancer ≤2 cm: an analysis from surveillance, epidemiology, and end results database. J Cardiothorac Surg 2021; 16:191. [PMID: 34233699 PMCID: PMC8265100 DOI: 10.1186/s13019-021-01568-x] [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: 05/27/2020] [Accepted: 06/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background No consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer (NSCLC) ≤ 2 cm. The aim of this study is to investigate the appropriate surgical procedure for stage I NSCLC ≤2 cm. Methods Patients with stage I NSCLC ≤2 cm received wedge resection, segmentectomy, lobectomy between January 2004 and December 2015 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Data were stratified by age, gender, race, side, location, grade, histology, extent of lymphadenectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients received wedge resection, segmentectomy, lobectomy. Univariate analysis and multivariable Cox regression were performed to identify the prognostic factors of OS and LCSS. Results A total of 16,511 patients with stage I NSCLC ≤2 cm were included in this study, of whom 2945 patients were classified as stage I NSCLC ≤1 cm. Lobectomy had better OS and LCSS when compared with wedge resection in patients with NSCLC ≤2 cm. Only OS favored lobectomy compared with segmentectomy in stage I NSCLC>1 to 2 cm. Multivariable analysis showed that segmentectomy had similar OS and LCSS compared with lobectomy in patients with stage I NSCLC ≤2 cm. Lymph node dissection (LND) was associated with better OS in patients with NSCLC ≤2 cm and better LCSS in patients with stage I NSCLC>1 to 2 cm. Conclusions Segmentectomy showed comparable survival compared with lobectomy in patients with stage I NSCLC ≤2 cm. LND can provide more accurate pathological stage, may affect survival, and should be recommended for above patients.
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Affiliation(s)
- Liang Wu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Weigang Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China.
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Zhang B, Liu R, Ren D, Li X, Wang Y, Huo H, Zhu S, Chen J, Song Z, Xu S. Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching's Study. Front Oncol 2021; 11:610638. [PMID: 34026604 PMCID: PMC8139614 DOI: 10.3389/fonc.2021.610638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/14/2021] [Indexed: 01/22/2023] Open
Abstract
Background To investigate the differences in survival between lobectomy and sub-lobar resection for elderly stage I non-small-cell lung cancer (NSCLC) patients using the Surveillance, Epidemiology, and End Results (SEER) registry. Method The data of stage IA elderly NSCLC patients (≥ 70 years) with tumors less than or equal to 3 cm in diameter were extracted. Propensity-matched analysis was used. Lung cancer-specific survival (LCSS) was compared among the patients after lobectomy and sub-lobar resection. The proportional hazards model was applied to identify multiple prognostic factors. Results A total of 3,504 patients met criteria after propensity score matching (PSM). Although the LCSS was better for lobectomy than for sub-lobar resection in patients with tumors ≤ 3 cm before PSM (p < 0.001), no significant difference in the LCSS was identified between the two treatment groups after PSM (p = 0.191). Multivariate Cox regression showed the elder age, male gender, squamous cell carcinoma (SQC) histology type, poor/undifferentiated grade and a large tumor size were associated with poor LCSS. The subgroup analysis of tumor sizes, histologic types and lymph nodes (LNs) dissection, there were also no significant difference for LCSS between lobectomy and sub-lobar resection. The sub-lobar resection was further divided into segmentectomy or wedge resection, and it demonstrated that no significant differences in LCSS were identified among the treatment subgroups either. Multivariate Cox regression analysis showed that the elder age, poor/undifferentiated grade and a large tumor size were a statistically significant independent factor associated with survival. Conclusion In terms of LCSS, lobectomy has no significant advantage over sub-lobar resection in elderly patients with stage IA NSCLC if lymph node assessment is performed adequately. The present data may contribute to develop a more suitable surgical treatment strategy for the stage IA elderly NSCLC patients.
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Affiliation(s)
- Bo Zhang
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Renwang Liu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dian Ren
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiongfei Li
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanye Wang
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Huandong Huo
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuai Zhu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumour Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumour Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumour Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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11
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Wang X, Chen K, Wang W, Li Q, Liu K, Li Q, Cui X, Tu W, Sun H, Xu S, Zhang R, Xiao Y, Fan L, Liu S. Can peritumoral regions increase the efficiency of machine-learning prediction of pathological invasiveness in lung adenocarcinoma manifesting as ground-glass nodules? J Thorac Dis 2021; 13:1327-1337. [PMID: 33841926 PMCID: PMC8024795 DOI: 10.21037/jtd-20-2981] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The peri-tumor microenvironment plays an important role in the occurrence, growth and metastasis of cancer. The aim of this study is to explore the value and application of a CT image-based deep learning model of tumors and peri-tumors in predicting the invasiveness of ground-glass nodules (GGNs). Methods Preoperative thin-section chest CT images were reviewed retrospectively in 622 patients with a total of 687 pulmonary GGNs. GGNs are classified according to clinical management strategies as invasive lesions (IAC) and non-invasive lesions (AAH, AIS and MIA). The two volumes of interest (VOIs) identified on CT were the gross tumor volume (GTV) and the gross volume of tumor incorporating peritumoral region (GPTV). Three dimensional (3D) DenseNet was used to model and predict GGN invasiveness, and five-fold cross validation was performed. We used GTV and GPTV as inputs for the comparison model. Prediction performance was evaluated by sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results The GTV-based model was able to successfully predict GGN invasiveness, with an AUC of 0.921 (95% CI, 0.896–0.937). Using GPTV, the AUC of the model increased to 0.955 (95% CI, 0.939–0.971). Conclusions The deep learning method performed well in predicting GGN invasiveness. The predictive ability of the GPTV-based model was more effective than that of the GTV-based model.
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Affiliation(s)
- Xiang Wang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Kaili Chen
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wei Wang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China.,71282 Hospital, Baoding, China
| | - Qingchu Li
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Kai Liu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Qianyun Li
- Department of Radiology, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Xing Cui
- Beijing Infervision Technology Co. Ltd., Beijing, China
| | - Wenting Tu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Hongbiao Sun
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Shaochun Xu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Rongguo Zhang
- Beijing Infervision Technology Co. Ltd., Beijing, China
| | - Yi Xiao
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
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12
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Shima T, Kinoshita T, Sasaki N, Uematsu M, Sugita Y, Shimizu R, Harada M, Hishima T, Yamamoto A, Horio H. Feasibility of intraoperative diagnosis of lung adenocarcinoma in situ to avoid excessive resection. J Thorac Dis 2021; 13:1338-1346. [PMID: 33841927 PMCID: PMC8024823 DOI: 10.21037/jtd-20-2710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Limited lung resection is generally believed to be available for lung adenocarcinoma in situ (AIS). At our institute, intraoperative hematoxylin-eosin staining of frozen-section slides is routinely performed for evaluating tumor invasiveness after partial resection to avoid excessive lung resection. This study aimed to evaluate the feasibility and usefulness of intraoperative frozen-section diagnosis of AIS. Methods We retrospectively reviewed 143 patients with 151 AISs diagnosed by intraoperative frozen sections between 2012 and 2019 at our institute. All patients underwent limited resection because of the result of intraoperative frozen-section diagnosis. Results The total concordance rate between the diagnoses of AIS by intraoperative frozen sections and postoperative paraffin-embedded sections was 82.7% for 151 nodules. Although 21 minimally invasive adenocarcinomas (MIA) and 5 invasive adenocarcinomas were diagnosed as AIS intraoperatively, no patient had tumor recurrence after resection. Among 125 pathologically proven cases of AIS postoperatively, there were 67 (53.6%) radiologically invasive tumors including ground-glass nodules (GGNs) with part-solid component or pure-solid nodules. Conclusions This intraoperative evaluation of frozen-section slides will help surgeons avoid excessive lung resection for AIS that was radiologically diagnosed as invasive adenocarcinoma. Intraoperative frozen-section diagnosis will provide to be clinically useful and lead to less invasive surgical treatment for lung nodules.
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Affiliation(s)
- Toshiyuki Shima
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomonari Kinoshita
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naomichi Sasaki
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Mao Uematsu
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yusuke Sugita
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Reiko Shimizu
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masahiko Harada
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Aya Yamamoto
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hirotoshi Horio
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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13
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Soares MS, Coltro LM, Leite PHC, Costa PB, Lauricella LL, Pêgo-Fernandes PM, Terra RM. Evolution of the surgical treatment of lung cancer at a tertiary referral center in Brazil, 2011-2018. ACTA ACUST UNITED AC 2020; 47:e20190426. [PMID: 33331462 PMCID: PMC7889323 DOI: 10.36416/1806-3756/e20190426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the evolution of clinical and epidemiological data, as well as data related to diagnosis, staging, treatment, and survival, among patients undergoing curative surgery for lung cancer at a tertiary referral center in the city of São Paulo, Brazil. Methods: This was a retrospective study of cases in the International Association for the Study of Lung Cancer database. We selected only cases of patients undergoing curative surgery between January of 2011 and April of 2018. We determined overall and disease-free survival at 36 months and compared the data between two periods (2011-2014 and 2015-2018). Results: Comparing the two periods (N = 437 cases), we observed trends toward increases in the number of female patients, as well as in the proportions of former smokers (44.09% vs. 53.59%), of patients diagnosed with adenocarcinoma (52.21% vs. 59.72%), and of patients diagnosed at an earlier pathological stage, together with a decrease in 30-day mortality (4.05% vs. 2.39%). There were significant increases in the proportions of cases diagnosed at an earlier clinical stage (p = 0.002) or incidentally (p = 0.003). Although lobectomy was the main surgical technique employed, there was a proportional increase in segmentectomies (2.67% vs. 7.11%; p = 0.026). Overall and disease-free survival rates were 79.4% (95% CI: 74.0-83.9%) and 75.1% (95% CI: 69.1-80.1%), respectively. The difference in overall survival between the periods lost statistical significance when adjusted for pathological stage, the only factor that affected survival (log-rank: p = 0.038 to p = 0.079). Conclusions: The clinical and epidemiological evolution presented in this study corroborates global trends. The decrease in 30-day mortality was probably due to better patient selection and improved surgical techniques.
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Affiliation(s)
- Mariana Schettini Soares
- . Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Pedro Henrique Cunha Leite
- . Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Priscila Berenice Costa
- . Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Letícia Leone Lauricella
- . Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.,. Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo Manuel Pêgo-Fernandes
- . Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo Mingarini Terra
- . Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.,. Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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14
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Tosi D, Nosotti M, Bonitta G, Mendogni P, Bertolaccini L, Spaggiari L, Brunelli A, Ruffini E, Falcoz PE. Anatomical segmentectomy versus pulmonary lobectomy for stage I non-small-cell lung cancer: patients selection and outcomes from the European Society of Thoracic Surgeons database analysis. Interact Cardiovasc Thorac Surg 2020; 32:546-551. [PMID: 33313840 DOI: 10.1093/icvts/ivaa298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The aims of this study were to describe the potential selection criteria for patients scheduled for lobectomy versus segmentectomy for stage I non-small-cell lung cancer and to compare the 2 procedures in terms of intraoperative variables and postoperative outcomes using the European Society of Thoracic Surgeons (ESTS) Registry. METHODS This observational multicentre retrospective cross-sectional study was based on data collected from the ESTS database. The following were set as inclusion criteria: pulmonary lobectomy or segmentectomy for stage I primary lung cancer (according to 8th TNM edition), no previous lung surgery and no induction chemotherapy or radiotherapy. Statistical significance was examined using Mann-Whitney or 2 proportions Z tests. RESULTS Among 63 542 patients enrolled in the ESTS database (2007-2018), 17 692 met the inclusion criteria: 15 845 patients received lobectomy and 1847 segmentectomy. Video-assisted thoracic surgery (VATS) lobectomy and VATS segmentectomy were the 27.8% and 31.9% of the procedures, respectively. Lobectomy group was significantly younger and had a lower American Society of Anaesthesiology (ASA) score, lower comorbidities prevalence and better respiratory function. The segmentectomy group had lower complications rate (25.6% vs 33.8%). When considering only the last 5 years, ASA score was similar between the 2 groups, although pulmonary function remained significantly lower in the segmentectomy group. CONCLUSIONS According to the ESTS database, segmentectomy was preferably offered to 'compromised' patients, with limited respiratory function, higher ASA score and relevant comorbidities. Nevertheless, the procedure showed lower complications rate and similar short-term outcomes compared to lobectomy. During the last 5 years, segmentectomy appeared to be regarded as a valid alternative, even for selected patients who could tolerate both procedures.
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Affiliation(s)
- Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Bonitta
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Turin, Italy
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15
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Koike T, Goto T, Sato S, Tsuchida M. Radical segmentectomy as a potential alternative surgical treatment with curative intent in early-stage non-small cell lung cancer. J Thorac Dis 2020; 12:6115-6119. [PMID: 33209445 PMCID: PMC7656425 DOI: 10.21037/jtd-20-1582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Goto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Seijiro Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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16
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Feasibility of limited resection for peripheral small-sized non-small cell lung cancer: a retrospective single-center-based study. J Cancer Res Clin Oncol 2020; 147:1519-1527. [PMID: 33151370 DOI: 10.1007/s00432-020-03441-1] [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: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to establish new criteria for limited resection of non-small cell lung cancer (NSCLC) based on computed tomography findings and maximum standardized uptake value (SUVmax). METHODS Between December 2007 and December 2015, 611 patients underwent lung cancer surgery; of these, 70 with cT1aN0M0 who underwent limited resection were enrolled. Criteria for undergoing intentional limited resection (ILR) were (1) tumor ground-glass opacity (GGO) ratio of ≥ 0.75 and (2) tumor SUVmax ≤ 1.5. Patients who met criteria (1) and (2) underwent partial resection, and those who only met criteria (2) underwent segmentectomy as ILR. The control group was subjected to limited surgery without meeting the criteria. RESULTS Overall, 45 and 25 patients who met the criteria were included in the ILR and control groups, respectively. In the ILR group, 13 patients underwent partial resection, and 32 underwent segmentectomy; in the control group, 18 patients underwent partial resection and 7 underwent segmentectomy. According to our criteria, no relapsed cases occurred in the ILR group, although six patients showed recurrence of lung cancer in the control group. The 5-year overall survival (OS) rates in the ILR and control groups were 100% and 67.7%, respectively, and the relapse-free survival (RFS) rates were 100% and 61.6%, respectively. The log-rank test showed that this difference was statistically significant (OS: P < 0.0001, RFS: P < 0.0001). CONCLUSIONS SUVmax may serve as a predictive marker of recurrence to determine the treatment strategy for patients with NSCLC. Patients with low GGO ratio and low SUVmax may be cured by limited resection.
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17
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Lin SF, Zheng YZ, Li XQ, Xu HP, Wang JJ, Wang W, Huang QY, Wu D, Zhong CX, Fu SS, Yuan LX, Wang SC, Luo RX, Zhai WY, Yu BT, Zhu KS. Impact of treatment modality on long-term survival of stage IA small-cell lung cancer patients: a cohort study of the U.S. SEER database. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1292. [PMID: 33209872 PMCID: PMC7661878 DOI: 10.21037/atm-20-5525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The optimal treatment modality for patients with stage IA (T1N0M0) small-cell lung cancer (SCLC) is still unclear. Methods Patients who received surgical resection or chemo-radiotherapy (CRT) between January 2004 and December 2014 were identified from The Surveillance, Epidemiology and End Results (SEER) database. Surgical resection included lobectomy, wedge resection, segmentectomy with lymphadenectomy [examined lymph node (ELN) ≥1]. Propensity score match analysis was utilized to balance the baseline characteristics. Results A total of 686 stage IA SCLC cases were included: 337 patients underwent surgery and 349 patients were treated by CRT alone. Surgery achieved a better outcome than CRT alone, with an adjusted hazard ratio (HR) of 0.495. Patients who underwent lobectomy demonstrated a longer overall survival (OS), compared to those who received sublobectomy (crude cohort, median OS, 69 vs. 38 months; match cohort, median OS, 67 vs. 38 months). Patients with ELN >7 presented with longer OS than those with ELN ≤7 (crude cohort, median OS, 91 vs. 49 months; matched cohort, median OS, 91 vs. 54 months). The additional efficacy of chemotherapy or radiotherapy in patients receiving lobectomy was observed. The best prognosis was achieved in the lobectomy plus CRT cohort, with a 5-year survival rate of 73.5%. Conclusions The prolonged survival associated with lobectomy and chemotherapy or radiotherapy presents a viable treatment option in the management of patients with stage IA SCLC.
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Affiliation(s)
- Shao-Feng Lin
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital& Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Yu-Zhen Zheng
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Hai-Peng Xu
- Department of Thoracic Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jun-Jie Wang
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wei Wang
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Qing-Yuan Huang
- Department of Thoracic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Da Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chen-Xi Zhong
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lian-Xiong Yuan
- Office of Research Service, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangzhou, China
| | - Si-Chao Wang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Rui-Xing Luo
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wen-Yu Zhai
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation, Guangzhou, China
| | - Ben-Tong Yu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kun-Shou Zhu
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital& Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
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18
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Li X, Ren F, Wang S, He Z, Song Z, Chen J, Xu S. The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis. Front Oncol 2020; 10:1059. [PMID: 32793469 PMCID: PMC7386063 DOI: 10.3389/fonc.2020.01059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: Due to the introduction of low-dose computed tomography (CT) and screening procedures, the proportion of early-stage lung cancer with ground glass opacity (GGO) manifestation is increasing in clinical practice. However, its epidemiological characteristics is still not fully investigated. Methods: We retrieved all solitary GGO adenocarcinoma lung cancer (ADLC) on the PubMed, Cochrane Library, and Embase databases until January 1, 2019 and extracted the general information to perform the meta-analysis, mainly focusing on age, gender, and smoking status. Results: A total of 8,793 solitary GGO ADLC patients from 53 studies were included in this analysis. The final pooled analysis showed that the female proportion, average diagnosis age, and non-smoking proportion of solitary GGO ADLC was 0.62 (95% CI, 0.60–0.64), 56.97 (95% CI, 54.56–59.37), and 0.72 (95% CI, 0.66–0.77), respectively. The cumulative meta-analysis and meta-trend analysis confirmed that the average age at diagnosis has been decreasing while the non-smoking proportion significantly increased in the past two decades. Conclusions: From our epidemiological analysis, it demonstrates that the clinical characteristics of GGO lung cancer patients may be out of the high-risk factors. Therefore, we propose to reconsider the risk assessment and current lung cancer screening criteria.
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Affiliation(s)
- Xiongfei Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuhang Wang
- Department of Clinical Trials Center, National Cancer Center, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhicheng He
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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19
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Piao Z, Han SJ, Cho HJ, Kang MW. Feasibility of electromagnetic navigation bronchoscopy-guided lung resection for pulmonary ground-glass opacity nodules. J Thorac Dis 2020; 12:2467-2473. [PMID: 32642153 PMCID: PMC7330407 DOI: 10.21037/jtd.2020.03.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Recent advances in imaging modalities and recommended low-dose computed tomography screening programs have made it easier to diagnose early lung cancer. However, the diagnosis of small ground-glass nodules (GGNs) has been problematic due to inappropriate specimen procurement and failure of conventional percutaneous core needle biopsy. Thus, we aimed to evaluate the usefulness of electromagnetic navigation bronchoscopy (ENB)-guided video-assisted lung resection for not only the diagnosis but also treatment of GGNs. Methods From 2017 to 2019, 110 patients with suspicious lung cancer lesions that were not diagnosed by conventional procedure underwent ENB-guided lung resection. Among 35 cases of GGNs, 33 cases of localization were included in this study (two cup biopsy cases were excluded). We used SuperDimension™ for the ENB procedure. After general anesthesia, indigo carmine (0.3–0.5 mL) was injected, and GGNs were resected through video-assisted thoracoscopic surgery. Results Of the 33 GGNs, 16 were pure (2 adenocarcinomas in situ, 5 minimally invasive adenocarcinomas (MIAs), 3 adenocarcinomas, and 6 benign lesions) and 17 were mixed (1 MIA, 11 adenocarcinomas, and 5 benign lesions). The mean size of all lesions was 11.2±7.78 mm, mean distance to the pleura was 11.2±14.2 mm, and mean ENB procedure time was 18.8±8.88 minutes. Dye localization and surgical resection of GGN were successful in all cases. There was no procedure-related complication. Conclusions ENB is a feasible and highly accurate localization method for minimally invasive lung resection of small GGNs.
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Affiliation(s)
- Zhe Piao
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Joon Han
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Jin Cho
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Min-Woong Kang
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Zheng YZ, Zhai WY, Zhao J, Luo RX, Gu WJ, Fu SS, Wu D, Yuan LX, Jiang W, Tsutani Y, Liao HY, Li XQ. Oncologic outcomes of lobectomy vs. segmentectomy in non-small cell lung cancer with clinical T1N0M0 stage: a literature review and meta-analysis. J Thorac Dis 2020; 12:3178-3187. [PMID: 32642239 PMCID: PMC7330803 DOI: 10.21037/jtd-19-3802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Lobectomy has long been regarded as the standard treatment for operable non-small cell lung cancer (NSCLC). Recent studies suggested that segmentectomy could achieve a good prognosis for early-stage NSCLC and might be an alternative to lobectomy in this cohort. Until now, on the issue of comparison between lobectomy and segmentectomy, there remains no published randomized controlled trial (RCT), and all existing evidence is low. Recently, a categorization of lower-level evidence has been proposed, namely, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The aim of this meta-analysis is to compare the oncologic outcome between lobectomy and segmentectomy in NSCLC with the clinical T1N0M0 stage according to the GRADE system. Methods PubMed, the PMC database, EMBASE, Web of Science, and the Cochrane library were searched prior to May 2019 to identify studies that compared the prognosis between lobectomy and segmentectomy for clinical T1N0M0 NSCLC. The evidence level of the included studies was assessed according to the GRADE system, including level IIA, probably not confounded nonrandomized comparison; level IIB, possibly confounded nonrandomized comparison; and level IIC, probably confounded nonrandomized comparison. The predefined outcomes included overall survival (OS) and disease-free survival (DFS). Univariable and multivariable hazard ratios (HRs) with 95% confidence intervals (95% CI) were pooled using a random-effects model. Results Twelve nonrandomized studies involving 8,072 participants were included. Of these studies, two were classified as IIA level (16.7%), six as IIB level (50.0%), and four as IIC level (33.3%). When crude HRs were included, compared with lobectomy, segmentectomy was associated with shorter OS but comparable DFS in the entire cohort (OS, pooled HR =1.45, 95% CI, 1.23 to 1.67; DFS, pooled HR =1.03, 95% CI, 0.65 to 1.82) and in patients with nodules ≤2 cm (OS, pooled HR =1.55, 95% CI, 1.33 to 1.80; DFS, pooled HR =0.98, 95% CI, 0.55 to 1.77). When adjusted HRs were included, the impact of segmentectomy on OS and DFS was comparable to that of lobectomy in the entire cohort (OS, pooled HR =1.39, 95% CI, 0.92 to 2.10; DFS, pooled HR =0.83, 95% CI, 0.66 to 1.03) and in patients with nodules ≤2 cm (OS, pooled HR =1.61, 95% CI, 0.87 to 3.00; DFS, pooled HR =0.90, 95% CI, 0.63 to 1.27). Conclusions Based on our results, although shorter OS is observed in patients received segmentectomy, it is necessary to wait for more results from RCT to draw a valid conclusion.
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Affiliation(s)
- Yu-Zhen Zheng
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Wen-Yu Zhai
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation, Guangzhou 510060, China
| | - Jian Zhao
- Department of Thoracic Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Rui-Xing Luo
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Wan-Jie Gu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical College of Nanjing University, Nanjing 210008, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Da Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Lian-Xiong Yuan
- Department of Science and Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 201100, China
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Hong-Ying Liao
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
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Lim K, Hsin MKY. Commentary: Resection for small cell lung cancer should be offered more often, and preferably anatomical. J Thorac Cardiovasc Surg 2020; 161:1495-1496. [PMID: 32359906 DOI: 10.1016/j.jtcvs.2020.03.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin Lim
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Michael K Y Hsin
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong SAR, China.
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Lin YH, Han HJ, Hsu HS. Solid-predominant ground-glass opacity has a higher recurrence rate. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_40_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Takahashi Y, Miyajima M, Tada M, Maki R, Mishina T, Watanabe A. Outcomes of completion lobectomy long after segmentectomy. J Cardiothorac Surg 2019; 14:116. [PMID: 31242948 PMCID: PMC6595588 DOI: 10.1186/s13019-019-0941-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. Methods We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. Results Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. Conclusions VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.
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Affiliation(s)
- Yuki Takahashi
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Masahiro Miyajima
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Makoto Tada
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Ryunosuke Maki
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Taijiro Mishina
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Atsushi Watanabe
- Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan.
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Uniportal VATS Coil-Assisted Resections for GGOs. JOURNAL OF ONCOLOGY 2019; 2019:5383086. [PMID: 31214259 PMCID: PMC6535831 DOI: 10.1155/2019/5383086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/11/2019] [Accepted: 04/30/2019] [Indexed: 01/15/2023]
Abstract
Backgrounds Although uniportal video-assisted thoracic surgery (VATS) theoretically allows the direct palpation of any zone of the lung through a small incision, sometimes it can be difficult to localize pure ground-glass opacities anyway. The aim of this study is to evaluate the usefulness and safety of preoperative computed tomography (CT)-guided microcoil localization of GGO nodules in patients undergoing uniportal VATS lung resection. Methods The clinical data and CT images of 30 consecutive patients (30 pulmonary nodules) who underwent preoperative CT-guided coil localization and subsequent uniportal VATS resection, from January 2017 to October 2018, were reviewed. Results All the CT-localization procedures have been performed with success (30/30) and the mean procedure time was 35±15 minutes. The mean size of the nodules was 15,53±6,72 mm, and the mean distance of the nodules from the pleural surface was 19,08±12,08 mm. Eleven nodules (36,7%) were pure ground-glass opacities and 19 (63,3%) were mixed ground-glass with a solid component of 50% or more. In 5 cases, the localization procedure was complicated by asymptomatic pneumothoraxes and in 1 case the pneumothorax required chest tube insertion. In any case a conversion to thoracotomy was avoided because all nodules were identified and resected through uniportal VATS. Conclusions Preoperative CT-guided coil localization seems to be a feasible, safe, and accurate procedure. It makes uniportal VATS an easy approach even for resecting small, deep, and impalpable nodules.
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Can peritumoral radiomics increase the efficiency of the prediction for lymph node metastasis in clinical stage T1 lung adenocarcinoma on CT? Eur Radiol 2019; 29:6049-6058. [PMID: 30887209 DOI: 10.1007/s00330-019-06084-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/07/2019] [Accepted: 02/08/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the efficiency of radiomics model on CT images of intratumoral and peritumoral lung parenchyma for preoperative prediction of lymph node (LN) metastasis in clinical stage T1 peripheral lung adenocarcinoma patients. METHODS Three hundred sixty-six peripheral lung adenocarcinoma patients with clinical stage T1 were evaluated using five CT scanners. For each patient, two volumes of interest (VOIs) on CT were defined as the gross tumor volume (GTV) and the peritumoral volume (PTV, 1.5 cm around the tumor). One thousand nine hundred forty-six radiomic features were obtained from each VOI, and then refined for reproducibility and redundancy. The refined features were investigated for usefulness in building radiomic signatures by mRMR feature ranking method and LASSO classifier. Multivariable logistic regression analysis was used to develop a radiomic nomogram incorporating the radiomic signature and clinical parameters. The prediction performance was evaluated on the validation cohort. RESULTS The radiomic signatures using the features of GTV and PTV showed a good ability in predicting LN metastasis with an AUC of 0.829 (95% CI, 0.745-0.913) and 0.825 (95% CI, 0.733-0.918), respectively. By incorporating the features of GTV and PTV, the AUC of radiomic signature increased to 0.843 (95% CI, 0.770-0.916). The AUC of radiomic nomogram was 0.869 (95% CI, 0.800-0.938). CONCLUSIONS Radiomic signatures of GTV and PTV both had a good prediction ability in the prediction of LN metastasis, and there is no significant difference of AUC between the two groups. The proposed nomogram can be conveniently used to facilitate the preoperative prediction of LN metastasis in T1 peripheral lung adenocarcinomas. KEY POINTS • Radiomics from peritumoral lung parenchyma increase the efficiency of the prediction for lymph node metastasis in clinical stage T1 lung adenocarcinoma on CT. • A radiomic nomogram was developed and validated to predict LN metastasis. • Different scan parameters on CT showed that radiomics signature had good predictive performance.
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Xue L, Fan H, Shi W, Ge D, Zhang Y, Wang Q, Yuan Y. Preoperative 3-dimensional computed tomography lung simulation before video-assisted thoracoscopic anatomic segmentectomy for ground glass opacity in lung. J Thorac Dis 2018; 10:6598-6605. [PMID: 30746205 DOI: 10.21037/jtd.2018.10.126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Three-dimensional (3D) simulation of pulmonary vessels and the space between the lesion and adjacent tissues may improve the safety and accuracy of video-assisted thoracoscopic surgery (VATS) for lung. The aim of this study was to evaluate the effect of 3D simulation on the outcome of VATS segmentectomy for ground glass opacity (GGO) in lung. Methods We retrospectively analyzed 68 cases of small (≤2 cm) GGO, which were diagnosed as cT1aN0M0 lung cancer, from May 1, 2016 to February 28, 2017 in our institute. All the patients underwent VATS segmentectomy. The patients were divided into "3D" group, 3D preoperative reconstruction simulation in 36 patients and "non-3D" group, 32 patients with only computed tomography (CT). Operation plans were firstly made by CT in all patients, then by 3D simulation only in 3D group. The clinical outcomes, including operation time, blood loss, resection margin distance, length of postoperative stay and postoperative complications were compared between the two groups. Results There were 21 male and 47 female analyzed, aging from 34 to 72 years (median 57). In 3D group, pathological result showed 8 cases of adenocarcinoma, 23 cases of microinvasive adenocarcinoma (MIA), 5 cases of adenocarcinoma in situ (AIS). In non-3D group, 18 cases of MIA, 9 cases of adenocarcinoma and 5 cases of AIS were diagnosed pathologically. The blood loss, postoperative hospital stay and the incidence of the postoperative complications were similar in both of the groups. There was no 30-day postoperative mortality in either group. The median operation time for the 3D group (111 minute) was shorter than non-3D group (139 minute) (P=0.03). Seven cases (19%) in 3D group changed the original operation plan according to the simulation result with the consideration of adequate resection margin distance. All cases in 3D group had adequate resection margin distance. Four cases (13%) in non-3D group got inadequate resection margin distance, and more lung tissues than the original plan were then resected in these patients (P=0.04). Conclusions 3D preoperative simulation may be more precise in operation plan than CT scan and can significantly shorten the operation time in VATS segmentectomy for GGO in lung.
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Affiliation(s)
- Liang Xue
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Fan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Woda Shi
- Department of Cardio-Thoracic Surgery, the Third People's Hospital of Yancheng City, Yancheng 224001, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yunfeng Yuan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Lu Q, Ma Y, An Z, Zhao T, Xu Z, Chen H. Epidermal growth factor receptor mutation accelerates radiographic progression in lung adenocarcinoma presented as a solitary ground-glass opacity. J Thorac Dis 2018; 10:6030-6039. [PMID: 30622774 DOI: 10.21037/jtd.2018.10.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background We aimed to investigate the impact of epidermal growth factor receptor (EGFR) mutation in the progression of lung adenocarcinoma presented as a solitary ground-glass opacity (GGO) by retrospectively evaluating the correlation between EGFR mutation status and the radiographic features. Methods One hundred fifty-six cases of lung adenocarcinoma presented as a solitary GGO were enrolled between 2013 and 2015. Chest CT scans were performed 3 times (1st ≥3 months, 2nd ≤1 week preoperatively and 3rd ≥3 months postoperatively) in each patient. The diameter and volume of every lesion was measured by semiautomated algorithm. EGFR mutation hotspots from exons 18, 19 and 21 were detected by real-time PCR. Results In the 156 patients who were enrolled in our study, tumors in 75 patients (48.1%) were pathologically diagnosed with EGFR-mutant, with 1, 29 and 45 cases harboring tumors with mutation in exon 18, 19 and 21, respectively. EGFR mutation occurred more frequently in women (P=0.005) and non-smokers (P=0.019). Comparison between the 1st and 2nd preoperative CT scans showed that 28 (37.3%) of 75 patients with EGFR mutations had an over 50% increment of tumor size and 38 (52.0%) displayed a growth of solid component. On the other hand, we found only 9 (11.1%) and 14 (17.3%) in 81 lesions without EGFR mutation had a distinct volume growth and component solidification, respectively, which is significantly less than that in EGFR mutation lesions (P<0.001). Further, in the postoperative CT scan, recurrent GGOs or nodes were identified in 6 (8%) EGFR-mutant patients and 6 (7.4%) in wild-type patients (P=0.89), which indicates no overt statistically difference. At last, we found that EGFR amplification is more frequent as GGO volume percentage decreases and diameter increases. Conclusions We found GGOs with EGFR mutation grew faster in volume and solidified more quickly in component than wild-type GGOs. Moreover, in the follow-up after surgery, patients in the EGFR mutation group and EGFR wild-type group showed no significant difference in the imaging evolvement.
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Affiliation(s)
- Qijue Lu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Ye Ma
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhao An
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Tiejun Zhao
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiyun Xu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Hezhong Chen
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Waller DA. Surgical management of lung cancer with multiple lesions: implication of the new recommendations of the 8 th edition of the TNM classification for lung cancer. J Thorac Dis 2018; 10:S2686-S2691. [PMID: 30345106 DOI: 10.21037/jtd.2018.04.159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The 8th tumour, node and metastasis (TNM) revision of the staging classification for lung cancer has attempted to clarify the different properties of four distinct clinical presentations: synchronous multiple primary lung cancers; primary tumour with intrapulmonary metastases; pneumonic-type adenocarcinoma and multiple ground glass/lepidic lesions. The respective biological profiles determine different surgical strategies for each category. Accurate preoperative histological confirmation is required to identify synchronous primary tumours which should then be managed as two separate episodes within the confines of patient characteristics. Equally important is the confirmation of intrapulmonary metastasis which indicates a more conservative resection of the smaller lesion. In contrast, pneumonic-type adenocarcinoma may require larger parenchymal resection to achieve anatomical clearance but also symptom relief. Multiple subsolid lesions require a carefully planned strategy of parenchymal sparing and possible observation of less malignant abnormalities. In all the above situations careful clinical, radiological and pathological assessment is imperative to avoid one embarking on inappropriate invasive management. Either when the widespread nature of the disease renders extensive surgery futile or the relative benign or pre-malignant nature of the multiple lesions imply that the risks of surgery outweigh the prognostic benefits.
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Koike T, Koike T, Nakamura M, Shimizu Y, Goto T, Sato S, Tsuchida M. Strategy of intentional limited resection for lung adenocarcinoma in situ. J Thorac Dis 2018; 10:S2018-S2021. [PMID: 30023107 DOI: 10.21037/jtd.2018.05.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Teruaki Koike
- Division of Surgery, Niigata Seirou Hospital, Niigata, Japan
| | - Masaya Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Shimizu
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Goto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Seijiro Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Wang Z, Ge M. [Progress of Lung Margin During Sublobar Resection for Early-staged Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:498-502. [PMID: 29945710 PMCID: PMC6022029 DOI: 10.3779/j.issn.1009-3419.2018.06.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
近年来随着低剂量计算机断层扫描(low-dose computed tomography, LDCT)、高分辨率CT(high-resolution CT, HRCT)的普及, 早期非小细胞肺癌的发现比率不断上升, 越来越多的胸外科医生探索手术方式的改良, 推动手术切除范围向更加合理的方向进展。临床研究发现肺切缘阴性较阳性有更低的局部肿瘤复发率, 因此亚肺叶切除术治疗早期肺癌术中保证肺切缘阴性具有重要的临床意义, 本文将就这一领域研究现状和进展作一综述。
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Affiliation(s)
- Zongkai Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Mingjian Ge
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Endoh M, Oizumi H, Kato H, Suzuki J, Watarai H, Hamada A, Suzuki K, Nakahashi K, Sadahiro M. Determination of the intersegmental plane using the slip-knot method. J Thorac Dis 2018; 10:S1222-S1228. [PMID: 29785297 DOI: 10.21037/jtd.2018.02.88] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Visualization of intersegmental planes in the lung is desirable for precise anatomical lung segmentectomy. We developed the slip-knot method for creating inflation-deflation lines. This study aimed to assess relevant data for thoracoscopic segmentectomy performed using this method. Methods In the slip-knot method, the objective segmental bronchus is looped with a monofilament thread. One end of the thread is then pulled during temporary bilateral ventilation, causing the knot to slip toward the bronchus. Thereafter, bronchial ligation is tightened to block the outflow of segmental air, ensuring that the segment remains expanded while the other reserved segments collapse on resumption of unilateral ventilation. Data from 221 patients who underwent thoracoscopic pulmonary segmentectomy between 2010 and 2016 were analyzed. Results A total of 147 patients (67%) were indicated for the slip-knot method, and 74 cases (33%) were non-adaptive cases. Ninety six percent of 147 cases were well adapted to the slip-knot method, which allowed us to obtain good inflation-deflation line images to determine the intersegmental plane. The mean operative time was 171±51 min (range, 71-367 min). The mean duration of chest tube insertion was 1.5±1.2 days (range, 1-7 days). Three cases (2.0%) had prolonged air-leakage and one (0.7%) case had readmission for late air-leakage. Conclusions Our method enables determination of anatomical intersegmental planes using only one monofilament thread, thus facilitating thoracoscopic pulmonary anatomical segmentectomy.
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Affiliation(s)
- Makoto Endoh
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Hiroyuki Oizumi
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Hirohisa Kato
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Jun Suzuki
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Hikaru Watarai
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Akira Hamada
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Katsuyuki Suzuki
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Kenta Nakahashi
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
| | - Mitsuaki Sadahiro
- Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan
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