Is Left Upper Lobectomy an Overtreatment for Patients with Stage I Lung Cancer in the Left Upper Lobe? A Propensity Score-Matched Analysis.

Öz

We aim to compare the outcomes of left upper lobectomy and segmentectomy for non-small cell lung cancer (NSCLC) located at the left upper lobe. We retrospectively reviewed the medical data of patients with NSCLC located in the left upper lobe who underwent segmentectomy or lobectomy between 1999 and 2016. Segmentectomy was preferred for patients with stage I who were also eligible for lobectomy and for patients who were not eligible for lobectomy due to limited cardiopulmonary reserve. In total, 127 patients were included into the propensity score analysis by using optimal data matching algorithm. After the 1:2 matching algorithm, 90 patients were divided into two groups; group 1 segmentectomy (n=30), and group 2 lobectomy (n=60). The morbidity, mortality, long-term survival rates and prognostic factors were analyzed. Histopathological investigation revealed 57 patients as stage I [group 1 (n=18), group 2 (n= 39)], 33 patients as stage II-IV [group 1 (n=12), group 2 (n= 21)]. Morbidity rate was 37.78% (37/90) [group 1: n=11 (36.67%), group 2: n=23 (38.33%), p=1.000] along with mortality rate of 1.11% [group 1: n=1 (3.33%), group 2: n=0 (0%), p=0.333]. In stage I patients, mean Kaplan-Meier survival time was 146.09 (95%CI: 111.70-180.49) for group I and 106.99 (95%CI: 77.68-136.30) for group 2 (p=0.185). This study revealed similar outcomes for patients with early stage NSCLC located at the left upper lobe undergoing either segmentectomy or lobectomy. In particular, lingulectomy or trisegmentectomy is recommended as a standard procedure for Stage I NSCLC compared to lobectomy.

Anahtar Kelimeler

• trisegmentectomy
• lingulectomy
• left upper lobectomy
• lung resection

Sol Üst Lob Evre I Akciğer Kanserli Hastalar İçin Sol Üst Lobektomi Aşırı Tedavi mi? Propensity Skor Analizi

Öz

Sol üst lobda yer alan küçük hücreli dışı akciğer kanseri (KHDAK) için sol üst lobektomi ve segmentektomi sonuçlarını karşılaştırmayı amaçladık. Kliniğimizde 1999-2016 yılları arasında sol üst lob yerleşimli KHDAK nedeniyle segmentektomi veya lobektomi uygulanan hastaların verilerini retrospektif olarak inceledik. Segmentektomi; lobektomi için uygun evre I hastalar ve sınırlı kardiyopulmoner rezervi nedeniyle lobektomi için uygun olmayan hastalarda uygulandı. Toplamda 127 hasta optimal veri eşleştirme algoritması kullanılarak propensity skoru analizine dahil edildi. 1: 2 eşleştirme algoritmasından sonra 90 hasta iki gruba ayrıldı; grup 1 segmentektomi (n=30) ve grup 2 lobektomi (n=60). Morbidite, mortalite, uzun dönem sağkalım oranları ve prognostik faktörler analiz edildi. Histopatolojik incelemede 57 hasta evre I [grup 1 (n = 18), grup 2 (n = 39)], 33 hasta evre II-IV [grup 1 (n = 12), grup 2 (n = 21 )] tespit edildi. Morbidite oranı % 37.78 (37/90) [grup 1: n = 11 (% 36.67), grup 2: n = 23 (% 38.33), p = 1.000] ve mortalite oranı % 1.11 [grup 1: n = 1 (% 3.33), grup 2: n = 0 (% 0), p = 0.333] idi. Evre I hastalarda ortalama Kaplan-Meier sağkalım süresi grup 1 için 146.09 (% 95 CI: 111.70-180.49) ve grup 2 için 106.99 (% 95 CI: 77.68-136.30) idi (p = 0.185) olarak sonuçlandı. Bu çalışmada sol üst lobda segmentektomi veya lobektomi uygulanan erken evre KHDAK'li hastalar için benzer sonuçlar elde edildi. Özellikle lingulektomi veya trisegmentektomi, evre I KHDAK için lobektomiye kıyasla standart bir prosedür olarak önerilmektedir.

Anahtar Kelimeler

• trisegmentektomi
• lingulektomi
• sol üst lobektomi
• akciğer rezeksiyonu

Kaynakça

1. Van Schil PE, Balduyck B, De Waele M, Hendriks JM, Hertoghs M, Lauwers P. Surgical treatment of early-stage non-small-cell lung cancer. EJC Suppl. 2013 Sep;11(2):110-22.
2. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 1995;60:615-22; discussion 622-3.
3. Sienel W, Stremmel C, Kirschbaum A, Hinterberger L, Stoelben E, Hasse J, et al Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localisation and width of resection margins--implications for patient selection for segmentectomy. Eur J Cardiothorac Surg. 2007 Mar;31(3):522-7.
4. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf
5. Gossot D. Totally thoracoscopic left upper lobe tri-segmentectomy. Ann Cardiothorac Surg. 2014 Mar;3(2):197-201.
6. Houck WV, Fuller CB, McKenna RJ Jr. Video-assisted thoracic surgery upper lobe trisegmentectomy for early-stage left apical lung cancer. Ann Thorac Surg. 2004 Nov;78(5):1858-60. Review
7. Landreneau RJ, Normolle DP, Christie NA, Awais O, Wizorek JJ, Abbas G et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol. 2014 Aug 10;32(23):2449-55.
8. Nomori H, Okada M, editors. Illustrated Anatomical Segmentectomy for Lung Cancer. Springer 2012, ISBN 978-4-431-54143-1

9. Okada M, Mimae T, Tsutani Y, Nakayama H, Okumura S, Yoshimura M, Miyata Y. Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma. Ann Cardiothorac Surg. 2014 Mar;3(2):153-9
10. Soukiasian HJ, Hong E, McKenna RJ Jr. Video-assisted thoracoscopic trisegmentectomy and left upper lobectomy provide equivalent survivals for stage IA and IB lung cancer. J Thorac Cardiovasc Surg. 2012 Sep;144(3):S23-6.
11. Dziedzic DA, Rudzinski P, Langfort R, Orlowski T; Polish Lung Cancer Study Group (PLCSG). Risk Factors for Local and Distant Recurrence After Surgical Treatment in Patients With Non-Small-Cell Lung Cancer. Clin Lung Cancer. 2016. pii: S1525- 7304(16)00003-6.
12. Nomori H, Mori T, Izumi Y, Kohno M, Yoshimoto K, Suzuki M. Is completion lobectomy merited for unanticipated nodal metastases after radical segmentectomy for cT1 N0 M0/pN1-2 non-small cell lung cancer? J Thorac Cardiovasc Surg. 2012 Apr;143(4):820-4.
13. Zhong C, Fang W, Mao T, Yao F, Chen W, Hu D. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer. Ann Thorac Surg. 2012 Aug;94(2):362-7.
14. Bao F, Ye P, Yang Y, Wang L, Zhang C, Lv X, Hu J. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg. 2014 Jul;46(1):1-7.
15. Sawabata N, Miyaoka E, Asamura H, Nakanishi Y, Eguchi K, Mori M, et al. Japanese Lung Cancer Registry Study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade. J Thorac Oncol. 2011;6:1229-35
16. Rami-Porta R, Bolejack V, CrowleyJ, et al. The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2015; 10(7): 990-1003
17. Yu X, Zhang R, Zhang M, Lin Y, Zhang X, Wen Y, et al; written on behalf of the AME Thoracic Surgery Collaborative Group. Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21-30 mm. Transl Lung Cancer Res. 2021 Feb;10(2):900-913. doi: 10.21037/tlcr-20-1217. PMID: 33718031; PMCID: PMC7947415.
18. Carr SR, Schuchert MJ, Pennathur A, Wilson DO, Siegfried JM, Luketich JD, et al. Impact of tumor size on outcomes after anatomic lung resection for stage 1A non-small cell lung cancer based on the current staging system. J Thorac Cardiovasc Surg. 2012 Feb;143(2):390-7. doi: 10.1016/j.jtcvs.2011.10.023. Epub 2011 Dec 9. PMID: 22169444.
19. Chan EG, Chan PG, Mazur SN, Normolle DP, Luketich JD, et al. Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non-small cell lung cancer. J Thorac Cardiovasc Surg. 2021 May;161(5):1639-1648.e2. doi: 10.1016/j.jtcvs.2020.03.041. Epub 2020 Mar 23. PMID: 32331817.
20. Aprile V, Bertoglio P, Dini P, Palmiero G, Mussi A, Ambrogi MC, et al. Is left upper lobectomy always worthwhile for early stage lung cancer? A comparison between left upper lobectomy, trisegmentectomy, and lingulectomy. J Surg Oncol. 2018 Mar;117(4):618-624. doi: 10.1002/jso.24884. Epub 2017 Oct 19. PMID: 29049856.
21. Takizawa T, Haga M, Yagi N, Terashima M, Uehara H, Yokoyama A, et al. Pulmonary function after segmentectomy for small peripheral carcinoma of the lung. J Thorac Cardiovasc Surg. 1999 Sep;118(3):536-41.
22. Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005 Dec;80(6):2041-5
23. Keenan RJ, Landreneau RJ, Maley RH Jr, Singh D, Macherey R, Bartley S, et al. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg 2004;78:228 –33.
24. Kobayashi N, Kobayashi K, Kikuchi S, Goto Y, Ichimura H, Endo K, Sato Y. Long-term pulmonary function after surgery for lung cancer. Interact Cardiovasc Thorac Surg. 2017 May 1;24(5):727-732
25. Loukeri AA, Kampolis CF, Ntokou A, Tsoukalas G, Syrigos K. Metachronous and synchronous primary lung cancers: diagnostic aspects, surgical treatment, and prognosis. Clin Lung Cancer 2015;16(1):15-23.
26. Asakura K, Izumi Y, Kohno M, et al. Effect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: comparison between staplers and scissors in ex vivo pig lung. Eur J Cardiothorac Surg 2011;40:e34-8.
27. Miyasaka Y, Oh S, Takahashi N, et al. Postoperative complications and respiratory function following segmentectomy of the lung - comparison of the methods of making an inter-segmental plane. Interact Cardiovasc Thorac Surg 2011;12:426-9
28. Ojanguren A, Gossot D, Seguin-Givelet A. Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue? J Thorac Dis. 2016 Aug;8(8):2158-64.
29. Iwasaki A, Hamanaka W, Hamada T, Hiratsuka M, Yamamoto S, Shiraishi T, Shirakusa T. Comparison between a case-matched analysis of left upper lobe trisegmentectomy and left upper lobectomy for small size lung cancer located in the upper division. Thorac Cardiovasc Surg. 2007 Oct;55(7):454-7.
30. Witte B, Wolf M, Hillebrand H, Huertgen M. Split-lobe resections versus lobectomy for lung carcinoma of the left upper lobe: a pair-matched case-control study of clinical and oncological outcomes. Eur J Cardiothorac Surg. 2014 Jun;45(6):1034-9.