Minimally invasive segmentectomy versus lobectomy for stage ⅠA non-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Weiqiang ¹ , DANG Haili ² ,  GOU Yunjiu ³

1. The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Gastroenterology, Longnan Hospital of Traditional Chinese Medicine, Longnan, 746000, Gansu, P. R. China;
3. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Segmentectomy; lobectomy; non-small cell lung cancer; robot-assisted thoracoscopic surgery; video-assisted thoracoscopic surgery; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202302026

Video：

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Objective To systematically evaluate the clinical outcomes of minimally invasive lung segment resection and lobectomy resection for stageⅠA non-small cell lung cancer (NSCLC) in order to provide reference for clinical application. Methods Online databases including The Cochrane Library, PubMed, EMbase, Web of Science, SinoMed, CNKI, and Wanfang were searched from inception to January 21, 2023 by two researchers independently. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale (NOS). The prognostic indicators included the overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). The meta-analysis was performed using STATA 14.0. Results A total of 13 studies with 1 853 patients were enrolled in the final study, with NOS scores≥7 points. The results of meta-analysis showed that compared with the MILLR group, the blood loss was less [SMD=−0.36, 95%CI (−0.49, −0.23), P<0.001], postoperative drainage tube retention time [SMD=−0.34, 95%CI (−0.62, −0.05), P=0.019] and hospitalization time [SMD=−0.28, 95%CI (−0.40, −0.15), P<0.001] were shorter in the MILSR group. More lymph nodes [SMD=−0.65, 95%CI (−0.78, −0.53), P<0.001] and shorter operation time [SMD=0.20, 95%CI (0.07, 0.33), P=0.003] were found in the MILLR group. There were no statistical differences in the incidence of postoperative complications, postoperative recurrence rate, OS, DFS or RFS between the two groups. Conclusion Although the number of lymph nodes removed by MILSR is limited compared with MILLR, it does not affect the prognosis. MILSR has advantages in reducing intraoperative blood loss and shortening postoperative drainage tube retention time and hospital stay. For the surgical treatment of stageⅠA NSCLC, MILSR may be a more appropriate surgical approach.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Bizuayehu HM, Dadi AF, Ahmed KY, et al. Burden of 30 cancers among men: Global statistics in 2022 and projections for 2050 using population-based estimates. Cancer, 2024, 130(21): 3708-3723.
3.	Bade BC, Dela Cruz CS. Lung cancer 2020: Epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
4.	Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
5.	Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
6.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
7.	汤井双, 黄晶晶, 李志华, 等. 肺叶切除术与肺段切除术治疗直径≤2 cm浸润性肺腺癌的临床效果分析. 南京医科大学学报(自然科学版), 2022, 42(3): 387-392.Tang JS, Huang JJ, Li ZH, et al. Lung lobectomy versus segmental resection in the treatment of invasive lung adenocarcinoma ≤2 cm in diameter: Clinical effectiveness analysis. J Nanjing Med Univ (Nat Sci), 2022, 42(3): 387-392.
8.	Zheng YZ, Zhai WY, Zhao J, et al. 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(6): 3178-3187.
9.	Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
10.	Darras M, Ojanguren A, Forster C, et al. Short-term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm. Thorac Cancer, 2021, 12(4): 453-461.
11.	Nakamura H, Taniguchi Y, Miwa K, et al. Comparison of the surgical outcomes of thoracoscopic lobectomy, segmentectomy, and wedge resection for clinical stageⅠnon-small cell lung cancer. Thorac Cardiovasc Surg, 2011, 59(3): 137-141.
12.	Ren M, Meng Q, Zhou W, et al. Comparison of short-term effect of thoracoscopic segmentectomy and thoracoscopic lobectomy for the solitary pulmonary nodule and early-stage lung cancer. Onco Targets Ther, 2014, 7: 1343-1347.
13.	Shapiro M, Weiser TS, Wisnivesky JP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stageⅠlung cancer. J Thorac Cardiovasc Surg, 2009, 137(6): 1388-1393.
14.	Song CY, Sakai T, Kimura D, et al. Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stageⅠA non-small cell lung cancer: A propensity score matching study. J Thorac Dis, 2018, 10(8): 4891-4901.
15.	Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37(2): 456-460.
16.	Yamashita S, Tokuishi K, Anami K, et al. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: A single center experience. Eur J Cardiothorac Surg, 2012, 42(1): 83-88.
17.	Zhang L, Ma W, Li Y, et al. Comparative study of the anatomic segmentectomy versus lobectomy for clinical stageⅠA peripheral lung cancer by video assistant thoracoscopic surgery. J Cancer Res Ther, 2013, 9: 106-109.
18.	Zhong C, Fang W, Mao T, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stageⅠA lung cancer. Ann Thorac Surg, 2012, 94(2): 362-367.
19.	刘宗昂, 张苏宁. 胸腔镜肺段切除术在治疗早期非小细胞肺癌中的应用. 中国医科大学学报, 2019, 48(7): 663-666.Liu ZA, Zhang SN. Video-assisted thoracoscopic segmentectomy in the treatment of early-stage non-small cell lung cancer. J China Med Univ, 2019, 48(7): 663-666.
20.	吴禹池, 许世广, 徐惟, 等. 达芬奇机器人辅助肺叶和肺段切除术治疗ⅠA期非小细胞肺癌疗效的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(1): 58-64.Wu YC,Xu SG, Xu W, et al. The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(1): 58-64.
21.	武国栋, 张毅, 钱坤, 等. 胸腔镜肺段切除术治疗60岁以上ⅠA期非小细胞肺癌的近期疗效. 中国微创外科杂志, 2017, 17(1): 15-18.Wu GD, Zhang Y, Qian K, et al. Short-term effect of complete video-assisted thoracoscopic anatomic segmentectomy in stage ⅠA non-small cell lung cancer patients above 60 years old. Chin J Minim Invasive Surg, 2017, 17(1): 15-18.
22.	黄晓锋, 虞桂平, 糜烨东, 等. 胸腔镜肺叶切除术与肺段切除术治疗T1bN0M0期非小细胞肺癌的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(10): 1296-1302.Huang XF, Yu GP, Mi YD, et al. Efficacy of thoracoscopic lobectomy versus segmentectomy for T1bN0M0 non-small cell lung cancer: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(10): 1296-1302.
23.	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.
24.	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.
25.	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.
26.	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.
27.	Zeng W, Zhang W, Zhang J, et al. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stageⅠnon-small cell lung cancer. World J Surg Oncol, 2020, 18(1): 44-53.
28.	高永山, 张志杰, 付伟, 等. 单操作孔胸腔镜肺段切除治疗早期非小细胞肺癌的学习曲线. 中国微创外科杂志, 2021, 21(12): 1072-1076.Gao YS, Zhang ZJ, Fu W, et al. On learning curve of single utility port video-assisted thoracoscopic segmentectomy for early-stage non-small cell lung cancer. Chin J Minim Invasive Surg, 2021, 21(12): 1072-1076.
29.	张五星, 喻东亮, 熊剑文, 等. 胸腔镜下肺段切除与肺叶切除治疗Ⅰ期非小细胞肺癌: 系统回顾与荟萃分析. 中华胸心血管外科杂志, 2020, 36(4): 245-253.Zhang WX, Yu DL, Xiong JW, et al. Thoracoscopic segmentectomy versus lobectomy for stageⅠnon-small cell lung cancer: A systematic review and meta-analysis. Chin J Thorac Cardiovasc Surg, 2020, 36(4): 245-253.
30.	Rao S, Ye L, Min L, et al. Meta-analysis of segmentectomy versus lobectomy for radiologically pure solid or solid-dominant stageⅠA non-small cell lung cancer. J Cardiothorac Surg, 2019, 14(1): 197-204.
31.	Lim TY, Park S, Kang CH. A meta-analysis comparing lobectomy versus segmentectomy in stageⅠnon-small cell lung cancer. Korean J Thorac Cardiovasc Surg, 2019, 52(4): 195-204.
32.	Luo J, Yang S, Dong S. Selective mediastinal lymphadenectomy or complete mediastinal lymphadenectomy for clinical stageⅠnon-small cell lung cancer: A meta-analysis. Adv Ther, 2021, 38(12): 5671-5683.
33.	Xu Y, Qin Y, Ma D, et al. The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: A meta-analysis. J Cardiothorac Surg, 2022, 17(1): 107-115.
34.	Wang X, Guo H, Hu Q, et al. Pulmonary function after segmentectomy versus lobectomy in patients with early-stage non-small-cell lung cancer: A meta-analysis. J Int Med Res, 2021, 49(9): 1-14.
35.	Tomlinson MA, Treasure T. Insertion of a chest drain: How to do it. Br J Hosp Med, 1997, 58(6): 248-252.
36.	Zhang TX, Zhang Y, Liu ZD, et al. The volume threshold of 300 versus 100 mL/day for chest tube removal after pulmonary lobectomy: A meta-analysis. Interact Cardiovasc Thorac Surg, 2018, 27(5): 695-702.
37.	Liao HC, Yang SM, Hung MH, et al. Thoracoscopic surgery without drainage tube placement for peripheral lung nodules. Ann Thorac Surg, 2020, 109(3): 887-893.
38.	Lesser T, Doenst T, Lehmann T, et al. Lung bioposy without pleural drainage. Dtsch Arztebl Int, 2019, 116(19): 329-334.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Bizuayehu HM, Dadi AF, Ahmed KY, et al. Burden of 30 cancers among men: Global statistics in 2022 and projections for 2050 using population-based estimates. Cancer, 2024, 130(21): 3708-3723.
3. Bade BC, Dela Cruz CS. Lung cancer 2020: Epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
4. Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
5. Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
6. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
7. 汤井双, 黄晶晶, 李志华, 等. 肺叶切除术与肺段切除术治疗直径≤2 cm浸润性肺腺癌的临床效果分析. 南京医科大学学报(自然科学版), 2022, 42(3): 387-392.Tang JS, Huang JJ, Li ZH, et al. Lung lobectomy versus segmental resection in the treatment of invasive lung adenocarcinoma ≤2 cm in diameter: Clinical effectiveness analysis. J Nanjing Med Univ (Nat Sci), 2022, 42(3): 387-392.
8. Zheng YZ, Zhai WY, Zhao J, et al. 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(6): 3178-3187.
9. Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
10. Darras M, Ojanguren A, Forster C, et al. Short-term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm. Thorac Cancer, 2021, 12(4): 453-461.
11. Nakamura H, Taniguchi Y, Miwa K, et al. Comparison of the surgical outcomes of thoracoscopic lobectomy, segmentectomy, and wedge resection for clinical stageⅠnon-small cell lung cancer. Thorac Cardiovasc Surg, 2011, 59(3): 137-141.
12. Ren M, Meng Q, Zhou W, et al. Comparison of short-term effect of thoracoscopic segmentectomy and thoracoscopic lobectomy for the solitary pulmonary nodule and early-stage lung cancer. Onco Targets Ther, 2014, 7: 1343-1347.
13. Shapiro M, Weiser TS, Wisnivesky JP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stageⅠlung cancer. J Thorac Cardiovasc Surg, 2009, 137(6): 1388-1393.
14. Song CY, Sakai T, Kimura D, et al. Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stageⅠA non-small cell lung cancer: A propensity score matching study. J Thorac Dis, 2018, 10(8): 4891-4901.
15. Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37(2): 456-460.
16. Yamashita S, Tokuishi K, Anami K, et al. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: A single center experience. Eur J Cardiothorac Surg, 2012, 42(1): 83-88.
17. Zhang L, Ma W, Li Y, et al. Comparative study of the anatomic segmentectomy versus lobectomy for clinical stageⅠA peripheral lung cancer by video assistant thoracoscopic surgery. J Cancer Res Ther, 2013, 9: 106-109.
18. Zhong C, Fang W, Mao T, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stageⅠA lung cancer. Ann Thorac Surg, 2012, 94(2): 362-367.
19. 刘宗昂, 张苏宁. 胸腔镜肺段切除术在治疗早期非小细胞肺癌中的应用. 中国医科大学学报, 2019, 48(7): 663-666.Liu ZA, Zhang SN. Video-assisted thoracoscopic segmentectomy in the treatment of early-stage non-small cell lung cancer. J China Med Univ, 2019, 48(7): 663-666.
20. 吴禹池, 许世广, 徐惟, 等. 达芬奇机器人辅助肺叶和肺段切除术治疗ⅠA期非小细胞肺癌疗效的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(1): 58-64.Wu YC,Xu SG, Xu W, et al. The efficacy of da Vinci robot-assisted lobectomy versus segmentectomy for stage ⅠA non-small cell lung cancer: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(1): 58-64.
21. 武国栋, 张毅, 钱坤, 等. 胸腔镜肺段切除术治疗60岁以上ⅠA期非小细胞肺癌的近期疗效. 中国微创外科杂志, 2017, 17(1): 15-18.Wu GD, Zhang Y, Qian K, et al. Short-term effect of complete video-assisted thoracoscopic anatomic segmentectomy in stage ⅠA non-small cell lung cancer patients above 60 years old. Chin J Minim Invasive Surg, 2017, 17(1): 15-18.
22. 黄晓锋, 虞桂平, 糜烨东, 等. 胸腔镜肺叶切除术与肺段切除术治疗T1bN0M0期非小细胞肺癌的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(10): 1296-1302.Huang XF, Yu GP, Mi YD, et al. Efficacy of thoracoscopic lobectomy versus segmentectomy for T1bN0M0 non-small cell lung cancer: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(10): 1296-1302.
23. 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.
24. 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.
25. 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.
26. 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.
27. Zeng W, Zhang W, Zhang J, et al. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stageⅠnon-small cell lung cancer. World J Surg Oncol, 2020, 18(1): 44-53.
28. 高永山, 张志杰, 付伟, 等. 单操作孔胸腔镜肺段切除治疗早期非小细胞肺癌的学习曲线. 中国微创外科杂志, 2021, 21(12): 1072-1076.Gao YS, Zhang ZJ, Fu W, et al. On learning curve of single utility port video-assisted thoracoscopic segmentectomy for early-stage non-small cell lung cancer. Chin J Minim Invasive Surg, 2021, 21(12): 1072-1076.
29. 张五星, 喻东亮, 熊剑文, 等. 胸腔镜下肺段切除与肺叶切除治疗Ⅰ期非小细胞肺癌: 系统回顾与荟萃分析. 中华胸心血管外科杂志, 2020, 36(4): 245-253.Zhang WX, Yu DL, Xiong JW, et al. Thoracoscopic segmentectomy versus lobectomy for stageⅠnon-small cell lung cancer: A systematic review and meta-analysis. Chin J Thorac Cardiovasc Surg, 2020, 36(4): 245-253.
30. Rao S, Ye L, Min L, et al. Meta-analysis of segmentectomy versus lobectomy for radiologically pure solid or solid-dominant stageⅠA non-small cell lung cancer. J Cardiothorac Surg, 2019, 14(1): 197-204.
31. Lim TY, Park S, Kang CH. A meta-analysis comparing lobectomy versus segmentectomy in stageⅠnon-small cell lung cancer. Korean J Thorac Cardiovasc Surg, 2019, 52(4): 195-204.
32. Luo J, Yang S, Dong S. Selective mediastinal lymphadenectomy or complete mediastinal lymphadenectomy for clinical stageⅠnon-small cell lung cancer: A meta-analysis. Adv Ther, 2021, 38(12): 5671-5683.
33. Xu Y, Qin Y, Ma D, et al. The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: A meta-analysis. J Cardiothorac Surg, 2022, 17(1): 107-115.
34. Wang X, Guo H, Hu Q, et al. Pulmonary function after segmentectomy versus lobectomy in patients with early-stage non-small-cell lung cancer: A meta-analysis. J Int Med Res, 2021, 49(9): 1-14.
35. Tomlinson MA, Treasure T. Insertion of a chest drain: How to do it. Br J Hosp Med, 1997, 58(6): 248-252.
36. Zhang TX, Zhang Y, Liu ZD, et al. The volume threshold of 300 versus 100 mL/day for chest tube removal after pulmonary lobectomy: A meta-analysis. Interact Cardiovasc Thorac Surg, 2018, 27(5): 695-702.
37. Liao HC, Yang SM, Hung MH, et al. Thoracoscopic surgery without drainage tube placement for peripheral lung nodules. Ann Thorac Surg, 2020, 109(3): 887-893.
38. Lesser T, Doenst T, Lehmann T, et al. Lung bioposy without pleural drainage. Dtsch Arztebl Int, 2019, 116(19): 329-334.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesMinimally invasive segmentectomy versus lobectomy for stage ⅠA non-small cell lung cancer: A systematic review and meta-analysis

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