Terumoto Koike1, Teruaki Koike2, Seijiro Sato1, Takehisa Hashimoto1, Tadashi Aoki2, Katsuo Yoshiya2, Yasushi Yamato3, Takehiro Watanabe4, Kohei Akazawa5, Shin-Ichi Toyabe6, Masanori Tsuchida1. 1. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 2. Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan. 3. Department of Thoracic Surgery, Japanese Red Cross Nagaoka Hospital, Nagaoka, Japan. 4. Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan. 5. Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan. 6. Niigata University Crisis Management Office, Niigata University, Niigata, Japan.
Abstract
BACKGROUND: Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques. METHODS:Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). RESULTS: The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups. The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV1 ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV1 ratios, respectively). CONCLUSIONS: A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing large-scale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.
RCT Entities:
BACKGROUND: Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques. METHODS: Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLCpatients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). RESULTS: The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups. The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV1 ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV1 ratios, respectively). CONCLUSIONS: A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing large-scale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.
Entities:
Keywords:
Lung cancer surgery; lobectomy; lung cancer clinical trials; segmentectomy; wedge resection
Authors: Rodney J Landreneau; Daniel P Normolle; Neil A Christie; Omar Awais; Joseph J Wizorek; Ghulam Abbas; Arjun Pennathur; Manisha Shende; Benny Weksler; James D Luketich; Matthew J Schuchert Journal: J Clin Oncol Date: 2014-06-30 Impact factor: 44.544
Authors: Takashi Eguchi; Kyuichi Kadota; Bernard J Park; William D Travis; David R Jones; Prasad S Adusumilli Journal: Semin Thorac Cardiovasc Surg Date: 2014-09-16
Authors: Robert J Keenan; Rodney J Landreneau; Richard H Maley; Deepak Singh; Robin Macherey; Susan Bartley; Tibetha Santucci Journal: Ann Thorac Surg Date: 2004-07 Impact factor: 4.330