Efficacy of thoracoscopic lobectomy versus segmentectomy for T1bN0M0 non-small cell lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Xiaofeng ,  YU Guiping , MI Yedong , SHAN Yibo , QIN Zhonghua

Department of Cardiothoracic Surgery, Jiangyin People’s Hospital, Jiangyin, 214400, Jiangsu, P. R. China;

Corresponding author：

YU Guiping, Email: xiaoyuer97103@163.com

Keywords：

Non-small cell lung cancer; thoracoscope; lobectomy; segmentectomy; prognosis

DOI：

10.7507/1007-4848.202107026

Video：

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Objective To investigate the clinical effect of thoracoscopic lobectomy versus segmentectomy in the treatment of T1bN0M0 non-small cell lung cancer (NSCLC). Methods Clinical data of 181 patients with T1bN0M0 NSCLC admitted to our hospital from 2012 to 2015 were retrospectively analyzed. They were divided into a lobectomy group and a segmentectomy group according to surgical methods. There were 117 patients in the lobectomy group (46 males and 71 females aged 61.32±8.94 years) and 64 patients in the segmentectomy group (20 males and 44 females aged 58.55±12.57 years). Perioperative indicators and prognosis were compared between the two groups. Results The segmentectomy group had longer operation time, less intraoperative blood loss, shorter postoperative hospital stay and more preservation of lung function compared with the lobectomy group (P<0.05). The lobectomy group had higher consolidation tumor ratio, bigger tumor diameter, and more lymph node sampling compared with the segmentectomy group (P<0.05). There was no statistical difference in 5-year overall survival or recurrence-free survival between the two groups (P<0.05). Conclusion For patients with T1bN0M0 NSCLC, thoracoscopic segmentectomy and lobectomy have similar prognosis, but segmentectomy has advantages with less injury and faster recovery over lobectomy.

Citation： HUANG Xiaofeng, YU Guiping, MI Yedong, SHAN Yibo, QIN Zhonghua. Efficacy of thoracoscopic lobectomy versus segmentectomy for T1bN0M0 non-small cell lung cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1296-1302. doi: 10.7507/1007-4848.202107026 Copy

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4.	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.
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6.	Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
7.	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.
8.	Aokage K, Saji H, Suzuki K, et al. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.
9.	Schuchert MJ, Normolle DP, Awais O, et al. Factors influencing recurrence following anatomic lung resection for clinical stage Ⅰnon-small cell lung cancer. Lung Cancer, 2019, 128: 145-151.
10.	Zhang J, Gold KA, Lin HY, et al. Relationship between tumor size and survival in non-small-cell lung cancer (NSCLC): An analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry. J Thorac Oncol, 2015, 10(4): 682-690.
11.	Yanagi S, Sugiura H, Morikawa T, et al. Tumor size does not have prognostic significance in stage Ⅰa NSCLC. Anticancer Res, 2000, 20(2b): 1155-1158.
12.	Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
13.	Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: Results of the American College of Surgery Oncology Group Z0030 trial. J Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
14.	Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤1 cm or >1 to 2 cm among lobectomy, segmentectomy, and wedge resection: A population-based study. J Clin Oncol, 2016, 34(26): 3175-3182.
15.	Hattori A, Hirayama S, Matsunaga T, et al. Distinct clinicopathologic characteristics and prognosis based on the presence of ground glass opacity component in clinical stage ⅠA lung adenocarcinoma. J Thorac Oncol, 2019, 14(2): 265-275.
16.	Ye T, Deng L, Xiang J, et al. Predictors of pathologic tumor invasion and prognosis for ground glass opacity featured lung adenocarcinoma. Ann Thorac Surg, 2018, 106(6): 1682-1690.
17.	Hattori A, Matsunaga T, Takamochi K, et al. Importance of ground glass opacity component in clinical stage ⅠA radiologic invasive lung cancer. Ann Thorac Surg, 2017, 104(1): 313-320.
18.	Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
19.	Asamura H, Hishida T, Suzuki K, et al. Radiographically determined noninvasive adenocarcinoma of the lung: Survival outcomes of Japan Clinical Oncology Group 0201. J Thorac Cardiovasc Surg, 2013, 146(1): 24-30.
20.	Qian F, Yang W, Wang R, et al. Prognostic significance and adjuvant chemotherapy survival benefits of a solid or micropapillary pattern in patients with resected stage ⅠB lung adenocarcinoma. J Thorac Cardiovasc Surg, 2018, 155(3): 1227-1235.e1222.
21.	Van Schil PE, Sihoe AD, Travis WD. Pathologic classification of adenocarcinoma of lung. J Surg Oncol, 2013, 108(5): 320-326.
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24.	Wang C, Yang J, Lu M. Micropapillary predominant lung adenocarcinoma in stageⅠA benefits from adjuvant chemotherapy. Ann Surg Oncol, 2020, 27(6): 2051-2060.
25.	Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival? A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. J Thorac Oncol, 2011, 6(9): 1496-1504.
26.	Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864-868.
27.	Spiezia L, Liew A, Campello E, et al. Thrombotic risk following video-assisted thoracoscopic surgery versus open thoracotomy: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2020, 30(4): 573-581.
28.	Li C, Hu Y, Huang J, et al. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage ⅡB-ⅢA non-small cell lung cancer. Transl Lung Cancer Res, 2019, 8(6): 820-828.
29.	Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
30.	赵常坤, 张勇, 王巍炜. 肺磨玻璃结节胸腔镜术前定位的研究进展. 医学综述, 2019, 25(16): 3274-3278.
31.	She XW, Gu YB, Xu C, et al. Three-dimensional (3D)-computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer. Thorac Cancer, 2018, 9(2): 305-309.
32.	单一波, 蒋薛伟, 沈飞, 等. 3D-CTBA联合Hookwire定位在胸腔镜肺段切除术中的应用. 中华腔镜外科杂志(电子版), 2020, 13(5): 265-269.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2019版). 肿瘤研究与临床, 2020, 32(4): 217-249.
3. 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.
4. 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.
5. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: Non-small cell lung cancer, version 2. 2021. J Natl Compr Canc Netw, 2021, 19(3): 254-266.
6. Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
7. 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.
8. Aokage K, Saji H, Suzuki K, et al. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.
9. Schuchert MJ, Normolle DP, Awais O, et al. Factors influencing recurrence following anatomic lung resection for clinical stage Ⅰnon-small cell lung cancer. Lung Cancer, 2019, 128: 145-151.
10. Zhang J, Gold KA, Lin HY, et al. Relationship between tumor size and survival in non-small-cell lung cancer (NSCLC): An analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry. J Thorac Oncol, 2015, 10(4): 682-690.
11. Yanagi S, Sugiura H, Morikawa T, et al. Tumor size does not have prognostic significance in stage Ⅰa NSCLC. Anticancer Res, 2000, 20(2b): 1155-1158.
12. Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
13. Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: Results of the American College of Surgery Oncology Group Z0030 trial. J Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
14. Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤1 cm or >1 to 2 cm among lobectomy, segmentectomy, and wedge resection: A population-based study. J Clin Oncol, 2016, 34(26): 3175-3182.
15. Hattori A, Hirayama S, Matsunaga T, et al. Distinct clinicopathologic characteristics and prognosis based on the presence of ground glass opacity component in clinical stage ⅠA lung adenocarcinoma. J Thorac Oncol, 2019, 14(2): 265-275.
16. Ye T, Deng L, Xiang J, et al. Predictors of pathologic tumor invasion and prognosis for ground glass opacity featured lung adenocarcinoma. Ann Thorac Surg, 2018, 106(6): 1682-1690.
17. Hattori A, Matsunaga T, Takamochi K, et al. Importance of ground glass opacity component in clinical stage ⅠA radiologic invasive lung cancer. Ann Thorac Surg, 2017, 104(1): 313-320.
18. Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
19. Asamura H, Hishida T, Suzuki K, et al. Radiographically determined noninvasive adenocarcinoma of the lung: Survival outcomes of Japan Clinical Oncology Group 0201. J Thorac Cardiovasc Surg, 2013, 146(1): 24-30.
20. Qian F, Yang W, Wang R, et al. Prognostic significance and adjuvant chemotherapy survival benefits of a solid or micropapillary pattern in patients with resected stage ⅠB lung adenocarcinoma. J Thorac Cardiovasc Surg, 2018, 155(3): 1227-1235.e1222.
21. Van Schil PE, Sihoe AD, Travis WD. Pathologic classification of adenocarcinoma of lung. J Surg Oncol, 2013, 108(5): 320-326.
22. Butnor KJ. Controversies and challenges in the histologic subtyping of lung adenocarcinoma. Translational lung cancer research, 2020, 9(3): 839-846.
23. Choi SH, Jeong JY, Lee SY, et al. Clinical implication of minimal presence of solid or micropapillary subtype in early-stage lung adenocarcinoma. Thorac Cancer, 2021, 12(2): 235-244.
24. Wang C, Yang J, Lu M. Micropapillary predominant lung adenocarcinoma in stageⅠA benefits from adjuvant chemotherapy. Ann Surg Oncol, 2020, 27(6): 2051-2060.
25. Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival? A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. J Thorac Oncol, 2011, 6(9): 1496-1504.
26. Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864-868.
27. Spiezia L, Liew A, Campello E, et al. Thrombotic risk following video-assisted thoracoscopic surgery versus open thoracotomy: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2020, 30(4): 573-581.
28. Li C, Hu Y, Huang J, et al. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage ⅡB-ⅢA non-small cell lung cancer. Transl Lung Cancer Res, 2019, 8(6): 820-828.
29. Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
30. 赵常坤, 张勇, 王巍炜. 肺磨玻璃结节胸腔镜术前定位的研究进展. 医学综述, 2019, 25(16): 3274-3278.
31. She XW, Gu YB, Xu C, et al. Three-dimensional (3D)-computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer. Thorac Cancer, 2018, 9(2): 305-309.
32. 单一波, 蒋薛伟, 沈飞, 等. 3D-CTBA联合Hookwire定位在胸腔镜肺段切除术中的应用. 中华腔镜外科杂志(电子版), 2020, 13(5): 265-269.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of thoracoscopic lobectomy versus segmentectomy for T1bN0M0 non-small cell lung cancer: A retrospective cohort study

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