Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHEN Chang ¹ , ZHU Yuming ¹ , JIANG Gening ¹ , WANG Haifeng ¹ , XIE Dong ¹ , SU Hang ¹ , XU Long ¹ , ZHAO Deping ¹ , DUAN Liang ¹ , XIE Boxiong ¹ , WU Chunyan ² , HOU Likun ² , XIE Huikang ² , FAN Junqiang ³ , ZHANG Xuedong ⁴ , SHI Weirong ⁴ , KE Honggang ⁵ , ZHANG Lei ¹ , WANG Hao ¹ , HU Xuefei ¹ , CHEN Qiankun ¹ , JIANG Lei ¹ , HE Wenxin ¹ , ZHOU Yiming ¹ , QIN Xiong ¹ , ZHAO Xiaogang ¹ , LIU Hongcheng ¹ , ZHANG Peng ¹ , YANG Yang ¹ , LIU Ming ¹ , ZHENG Hui ¹

1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P.R.China;
2. Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P.R.China;
3. Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R.China;
4. Department of Thoracic Surgery, The Sixth People's Hospital of Nantong, Shanghai University, Nantong, 216002, Jiangsu, P.R.China;
5. Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, P.R.China;

Corresponding author：

CHEN Chang, Email: chenthoracic@163.com

Keywords：

Segmentectomy; lobectomy; micropapillary; solid; lung adenocarcinoma; randomized controlled trial

DOI：

10.7507/1007-4848.202104078

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Objective To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections.Methods The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed.Results There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041).Conclusion Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.

Citation： CHEN Chang, ZHU Yuming, JIANG Gening, WANG Haifeng, XIE Dong, SU Hang, XU Long, ZHAO Deping, DUAN Liang, XIE Boxiong, WU Chunyan, HOU Likun, XIE Huikang, FAN Junqiang, ZHANG Xuedong, SHI Weirong, KE Honggang, ZHANG Lei, WANG Hao, HU Xuefei, CHEN Qiankun, JIANG Lei, HE Wenxin, ZHOU Yiming, QIN Xiong, ZHAO Xiaogang, LIU Hongcheng, ZHANG Peng, YANG Yang, LIU Ming, ZHENG Hui. Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1292-1298. doi: 10.7507/1007-4848.202104078 Copy

1.	Parikh AR. Lung cancer genomics. Acta Med Acad, 2019, 48(1): 78-83.
2.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
3.	Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
4.	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage ⅠA lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
5.	Wisnivesky JP, Henschke CI, Swanson S, et al. Limited resection for the treatment of patients with stage ⅠA lung cancer. Ann Surg, 2010, 251(3): 550-554.
6.	Asamura H. Role of limited sublobar resection for early-stage lung cancer: Steady progress. J Clin Oncol, 2014, 32(23): 2403-2404.
7.	Yanagawa N, Shiono S, Abiko M, et al. New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stage Ⅰ lung adenocarcinoma. J Thorac Oncol, 2013, 8(5): 612-618.
8.	Dai C, Xie H, Kadeer X, et al. Relationship of lymph node micrometastasis and micropapillary component and their joint influence on prognosis of patients with stage Ⅰ lung adenocarcinoma. Am J Surg Pathol, 2017, 41(9): 1212-1220.
9.	Dai C, Xie H, Su H, et al. Tumor spread through air spaces affects the recurrence and overall survival in patients with lung adenocarcinoma > 2 to 3 cm. J Thorac Oncol, 2017, 12(7): 1052-1060.
10.	Travis WD, Brambilla E, Rami-Porta R, et al. Visceral pleural invasion: Pathologic criteria and use of elastic stains: Proposal for the 7th edition of the TNM classification for lung cancer. J Thorac Oncol, 2008, 3(12): 1384-1390.
11.	Zhao Y, Wang R, Shen X, et al. Minor components of micropapillary and solid subtypes in lung adenocarcinoma are predictors of lymph node metastasis and poor prognosis. Ann Surg Oncol, 2016, 23(6): 2099-2105.
12.	Nitadori J, Bograd AJ, Kadota K, et al. Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2 cm or smaller. J Natl Cancer Inst, 2013, 105(16): 1212-1220.
13.	Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
14.	Su H, Xie H, Dai C, et al. Procedure-specific prognostic impact of micropapillary subtype may guide resection strategy in small-sized lung adenocarcinomas: A multicenter study. Ther Adv Med Oncol, 2020, 12: 1758835920937893.
15.	Tsutani Y, Nakayama H, Ito H, et al. Long-term outcomes after sublobar resection versus lobectomy in patients with clinical stage ⅠA lung adenocarcinoma meeting the node-negative criteria defined by high-resolution computed tomography and [18F]-Fluoro-2-Deoxy-d-Glucose positron emission tomography. Clin Lung Cancer, 2021, 22(3): e431-e437.
16.	Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
17.	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
18.	Yeh YC, Nitadori J, Kadota K, et al. Using frozen section to identify histological patterns in stage Ⅰ lung adenocarcinoma of ≤3 cm: Accuracy and interobserver agreement. Histopathology, 2015, 66(7): 922-938.
19.	Trejo Bittar HE, Incharoen P, Althouse AD, et al. Accuracy of the IASLC/ATS/ERS histological subtyping of stage Ⅰ lung adenocarcinoma on intraoperative frozen sections. Mod Pathol, 2015, 28(8): 1058-1063.
20.	Eguchi T, Kameda K, Lu S, et al. Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score-matched analysis. J Thorac Oncol, 2019, 14(1): 87-98.
21.	Masai K, Sakurai H, Sukeda A, et al. Prognostic impact of margin distance and tumor spread through air spaces in limited resection for primary lung cancer. J Thorac Oncol, 2017, 12(12): 1788-1797.

1. Parikh AR. Lung cancer genomics. Acta Med Acad, 2019, 48(1): 78-83.
2. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
3. Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
4. Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage ⅠA lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
5. Wisnivesky JP, Henschke CI, Swanson S, et al. Limited resection for the treatment of patients with stage ⅠA lung cancer. Ann Surg, 2010, 251(3): 550-554.
6. Asamura H. Role of limited sublobar resection for early-stage lung cancer: Steady progress. J Clin Oncol, 2014, 32(23): 2403-2404.
7. Yanagawa N, Shiono S, Abiko M, et al. New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stage Ⅰ lung adenocarcinoma. J Thorac Oncol, 2013, 8(5): 612-618.
8. Dai C, Xie H, Kadeer X, et al. Relationship of lymph node micrometastasis and micropapillary component and their joint influence on prognosis of patients with stage Ⅰ lung adenocarcinoma. Am J Surg Pathol, 2017, 41(9): 1212-1220.
9. Dai C, Xie H, Su H, et al. Tumor spread through air spaces affects the recurrence and overall survival in patients with lung adenocarcinoma > 2 to 3 cm. J Thorac Oncol, 2017, 12(7): 1052-1060.
10. Travis WD, Brambilla E, Rami-Porta R, et al. Visceral pleural invasion: Pathologic criteria and use of elastic stains: Proposal for the 7th edition of the TNM classification for lung cancer. J Thorac Oncol, 2008, 3(12): 1384-1390.
11. Zhao Y, Wang R, Shen X, et al. Minor components of micropapillary and solid subtypes in lung adenocarcinoma are predictors of lymph node metastasis and poor prognosis. Ann Surg Oncol, 2016, 23(6): 2099-2105.
12. Nitadori J, Bograd AJ, Kadota K, et al. Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2 cm or smaller. J Natl Cancer Inst, 2013, 105(16): 1212-1220.
13. Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
14. Su H, Xie H, Dai C, et al. Procedure-specific prognostic impact of micropapillary subtype may guide resection strategy in small-sized lung adenocarcinomas: A multicenter study. Ther Adv Med Oncol, 2020, 12: 1758835920937893.
15. Tsutani Y, Nakayama H, Ito H, et al. Long-term outcomes after sublobar resection versus lobectomy in patients with clinical stage ⅠA lung adenocarcinoma meeting the node-negative criteria defined by high-resolution computed tomography and [18F]-Fluoro-2-Deoxy-d-Glucose positron emission tomography. Clin Lung Cancer, 2021, 22(3): e431-e437.
16. Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
17. Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
18. Yeh YC, Nitadori J, Kadota K, et al. Using frozen section to identify histological patterns in stage Ⅰ lung adenocarcinoma of ≤3 cm: Accuracy and interobserver agreement. Histopathology, 2015, 66(7): 922-938.
19. Trejo Bittar HE, Incharoen P, Althouse AD, et al. Accuracy of the IASLC/ATS/ERS histological subtyping of stage Ⅰ lung adenocarcinoma on intraoperative frozen sections. Mod Pathol, 2015, 28(8): 1058-1063.
20. Eguchi T, Kameda K, Lu S, et al. Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score-matched analysis. J Thorac Oncol, 2019, 14(1): 87-98.
21. Masai K, Sakurai H, Sukeda A, et al. Prognostic impact of margin distance and tumor spread through air spaces in limited resection for primary lung cancer. J Thorac Oncol, 2017, 12(12): 1788-1797.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial

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