Alfonso Fiorelli1, Francesco Paolo Caronia2, Niccolò Daddi3, Domenico Loizzi4, Luca Ampollini5, Nicoletta Ardò4, Luigi Ventura5, Paolo Carbognani5, Rossella Potenza6, Francesco Ardissone7, Francesco Sollitto4, Sandro Mattioli3, Francesco Puma6, Mario Santini8, Mark Ragusa9. 1. Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy. alfonso.fiorelli@unina2.it. 2. Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy. 3. Thoracic Surgery Unit, University of Bologna, Bologna, Italy. 4. Thoracic Surgery Unit, University of Foggia, Foggia, Italy. 5. Thoracic Surgery Unit, University of Parma, Parma, Italy. 6. Thoracic Surgery Unit, University of Perugia, Perugia, Italy. 7. Thoracic Surgery Unit, San Luigi Hospital, University of Turin, Turin, Italy. 8. Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy. 9. Thoracic Surgery Unit, University of Terni, Terni, Italy.
Abstract
PURPOSES: The aim of this study was to evaluate whether sublobar resection could achieve recurrence and survival rates equivalent to lobectomy in high-risk elderly patients. METHODS: We conducted a retrospective multicenter study that including all consecutive patients (aged >75 years) who underwent operation for clinical stage I non-small cell lung cancer (NSCLC). The clinicopathological data, postoperative morbidity and mortality, recurrence rate and vital status were retrieved. The overall survival, cancer-specific survival and disease-free survival were also assessed. RESULTS: Two hundred and thirty-nine patients (median age 78 years) were enrolled. Lobectomies were performed in 149 (62.3 %) patients and sublobar resections in 90 (39 segmentectomies, 51 wedge resections). There were no differences in the recurrence rates following lobar versus sublobar resections (19 versus 23 %, respectively; p = 0.5) or the overall survival (p = 0.1), cancer-specific survival (p = 0.3) or disease-free survival (p = 0.1). After adjusting for 1:1 propensity score matching and a matched pair analysis, the results remained unchanged. A tumor size >2 cm and pN2 disease were independent negative prognostic factors in unmatched (p = 0.01 and p = 0.0003, respectively) and matched (p = 0.02 and p = 0.005, respectively) analyses. CONCLUSIONS: High-risk elderly patients may benefit from sublobar resection, which provides an equivalent long-term survival compared to lobectomy.
PURPOSES: The aim of this study was to evaluate whether sublobar resection could achieve recurrence and survival rates equivalent to lobectomy in high-risk elderly patients. METHODS: We conducted a retrospective multicenter study that including all consecutive patients (aged >75 years) who underwent operation for clinical stage I non-small cell lung cancer (NSCLC). The clinicopathological data, postoperative morbidity and mortality, recurrence rate and vital status were retrieved. The overall survival, cancer-specific survival and disease-free survival were also assessed. RESULTS: Two hundred and thirty-nine patients (median age 78 years) were enrolled. Lobectomies were performed in 149 (62.3 %) patients and sublobar resections in 90 (39 segmentectomies, 51 wedge resections). There were no differences in the recurrence rates following lobar versus sublobar resections (19 versus 23 %, respectively; p = 0.5) or the overall survival (p = 0.1), cancer-specific survival (p = 0.3) or disease-free survival (p = 0.1). After adjusting for 1:1 propensity score matching and a matched pair analysis, the results remained unchanged. A tumor size >2 cm and pN2 disease were independent negative prognostic factors in unmatched (p = 0.01 and p = 0.0003, respectively) and matched (p = 0.02 and p = 0.005, respectively) analyses. CONCLUSIONS: High-risk elderly patients may benefit from sublobar resection, which provides an equivalent long-term survival compared to lobectomy.
Entities:
Keywords:
Elderly; Lobectomy; Non-small cell lung cancer; Sublobar resection; Surgery
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