BACKGROUND:Patients with early-stage lung cancer and limited pulmonary reserve may not be appropriate candidates for lobectomy. In these situations, sublobar resection (wedge or segmentectomy) is generally performed. Many physicians believe that segmentectomy is superior because it allows for an improved parenchymal margin and nodal sampling. METHODS: We performed an analysis using operative and pathology reports collected as part of planned data collection for American College of Surgeons Surgical Oncology Group (ACOSG) Z4032. This was a prospective trial in which patients with clinical stage I lung cancer and limited pulmonary function were randomized to sublobar resection with or without brachytherapy. The operative approach (video-assisted thoracic surgery [VATS] vs thoracotomy), extent of resection, and degree of lymph node evaluation were at the discretion of the individual surgeon. The primary aim of this analysis was to compare the parenchymal margin achieved between segmentectomy and wedge resection. Secondary aims included the extent of nodal staging and whether the operative approach (VATS vs open) had an effect on margin status and nodal evaluation. RESULTS: Among 210 patients, 135 (64%) underwent aVATS approach and 75 (36%) a thoracotomy. A segmentectomy was performed in 57 patients (27%) and a wedge resection in 153 patients (73%). There were no significant differences in the degree of nodal upstaging, stations sampled, or parenchymal margin obtained between VATS and thoracotomy. However, significant differences were observed between patients who underwent a segmentectomy and those who underwent a wedge resection with regard to parenchymal margin (1.5 cm vs 0.8 cm, p = 0.0001), nodal upstaging (9% vs 1%, p = 0.006), and nodal stations sampled (3 vs 1, p < 0.0001) . Notably, 41% of patients treated by wedge resection had no nodes sampled at the time of operation compared with 2% of those who underwent segmentectomy (p < 0.0001). CONCLUSIONS: In ACOSG Z4032, wedge resection, regardless of the approach, was associated with a smaller parenchymal margin and a lower yield of lymph nodes and rate of nodal upstaging when compared with segmentectomy.
RCT Entities:
BACKGROUND:Patients with early-stage lung cancer and limited pulmonary reserve may not be appropriate candidates for lobectomy. In these situations, sublobar resection (wedge or segmentectomy) is generally performed. Many physicians believe that segmentectomy is superior because it allows for an improved parenchymal margin and nodal sampling. METHODS: We performed an analysis using operative and pathology reports collected as part of planned data collection for American College of Surgeons Surgical Oncology Group (ACOSG) Z4032. This was a prospective trial in which patients with clinical stage I lung cancer and limited pulmonary function were randomized to sublobar resection with or without brachytherapy. The operative approach (video-assisted thoracic surgery [VATS] vs thoracotomy), extent of resection, and degree of lymph node evaluation were at the discretion of the individual surgeon. The primary aim of this analysis was to compare the parenchymal margin achieved between segmentectomy and wedge resection. Secondary aims included the extent of nodal staging and whether the operative approach (VATS vs open) had an effect on margin status and nodal evaluation. RESULTS: Among 210 patients, 135 (64%) underwent a VATS approach and 75 (36%) a thoracotomy. A segmentectomy was performed in 57 patients (27%) and a wedge resection in 153 patients (73%). There were no significant differences in the degree of nodal upstaging, stations sampled, or parenchymal margin obtained between VATS and thoracotomy. However, significant differences were observed between patients who underwent a segmentectomy and those who underwent a wedge resection with regard to parenchymal margin (1.5 cm vs 0.8 cm, p = 0.0001), nodal upstaging (9% vs 1%, p = 0.006), and nodal stations sampled (3 vs 1, p < 0.0001) . Notably, 41% of patients treated by wedge resection had no nodes sampled at the time of operation compared with 2% of those who underwent segmentectomy (p < 0.0001). CONCLUSIONS: In ACOSG Z4032, wedge resection, regardless of the approach, was associated with a smaller parenchymal margin and a lower yield of lymph nodes and rate of nodal upstaging when compared with segmentectomy.
Authors: Morgan L Cox; Chi-Fu Jeffrey Yang; Paul J Speicher; Kevin L Anderson; Zachary W Fitch; Lin Gu; Robert Patrick Davis; Xiaofei Wang; Thomas A D'Amico; Matthew G Hartwig; David H Harpole; Mark F Berry Journal: J Thorac Oncol Date: 2017-01-08 Impact factor: 15.609
Authors: Michael S Kent; Sumithra J Mandrekar; Rodney Landreneau; Francis Nichols; Nathan R Foster; Thomas A DiPetrillo; Bryan Meyers; Dwight E Heron; David R Jones; Angelina D Tan; Sandra Starnes; Joe B Putnam; Hiran C Fernando Journal: Ann Thorac Surg Date: 2016-04-19 Impact factor: 4.330
Authors: Eric M Robinson; Ilkka K Ilonen; Kay See Tan; Andrew J Plodkowski; Matthew Bott; Manjit S Bains; Prasad S Adusumilli; Bernard J Park; Valerie W Rusch; David R Jones; James Huang Journal: Ann Thorac Surg Date: 2019-08-31 Impact factor: 4.330
Authors: Alfonso Fiorelli; Francesco Paolo Caronia; Niccolò Daddi; Domenico Loizzi; Luca Ampollini; Nicoletta Ardò; Luigi Ventura; Paolo Carbognani; Rossella Potenza; Francesco Ardissone; Francesco Sollitto; Sandro Mattioli; Francesco Puma; Mario Santini; Mark Ragusa Journal: Surg Today Date: 2016-04-16 Impact factor: 2.549