Mohamed K Kamel1, Mohamed Rahouma1, Benjamin Lee1, Sebron W Harrison1, Brendon M Stiles1, Nasser K Altorki1, Jeffrey L Port2. 1. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York. 2. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York. Electronic address: jlp2002@med.cornell.edu.
Abstract
BACKGROUND: Recent studies have suggested that lobectomy and segmentectomy hold equivalent oncologic outcomes, particularly for small, peripheral, subsolid nodules. However, for hypermetabolic nodules that are frequently associated with high rates of nodal disease, recurrence, or mortality, the optimum oncologic procedure was not assessed. We hypothesize that for hypermetabolic, cT1 N0 adenocarcinoma, lobectomy and segmentectomy are associated with comparable outcomes. METHODS: A prospectively collected database was queried for patients with clinical stage IA lung adenocarcinoma who underwent lobectomy or segmentectomy (2000 to 2016) for hypermetabolic tumors (maximum standard uptake value [SUVmax] ≥ 3g/dL). To obtain balanced groups of patients, a propensity matching analysis was done. RESULTS: A total of 414 patients had hypermetabolic tumors and underwent lobectomy or segmentectomy. Patients were propensity matched (4:1) (lobectomy: n = 156, segmentectomy: n = 46). Patients in the lobectomy group had a higher rate of pathologic nodal upstaging (17% versus 7%, p = 0.085) and a higher pathologic upstaging rate (38% versus 26%, p = 0.143) than the segmentectomy group. In addition, the lobectomy group had a higher number of resected lymph nodes than the segmentectomy group (median lymph nodes resected: 14 versus 7, p < 0.001). No differences were found in in 5-year recurrence-free survival (RFS; 72% versus 69%, p = 0.679) or in 5-year cancer-specific survival (CSS; 92% versus 83%, p = 0.557) between patients who underwent lobectomy or segmentectomy, respectively. CONCLUSIONS: Our data show that lobectomy and segmentectomy are comparable oncologic procedures for patients with carefully staged cT1 N0 lung adenocarcinoma with hypermetabolic tumors (SUVmax ≥ 3g/dL). Although lobectomy was associated with a more thorough lymph node dissection, this did not translate into a higher rate of RFS or CSS compared with segmentectomy.
BACKGROUND: Recent studies have suggested that lobectomy and segmentectomy hold equivalent oncologic outcomes, particularly for small, peripheral, subsolid nodules. However, for hypermetabolic nodules that are frequently associated with high rates of nodal disease, recurrence, or mortality, the optimum oncologic procedure was not assessed. We hypothesize that for hypermetabolic, cT1 N0 adenocarcinoma, lobectomy and segmentectomy are associated with comparable outcomes. METHODS: A prospectively collected database was queried for patients with clinical stage IA lung adenocarcinoma who underwent lobectomy or segmentectomy (2000 to 2016) for hypermetabolic tumors (maximum standard uptake value [SUVmax] ≥ 3g/dL). To obtain balanced groups of patients, a propensity matching analysis was done. RESULTS: A total of 414 patients had hypermetabolic tumors and underwent lobectomy or segmentectomy. Patients were propensity matched (4:1) (lobectomy: n = 156, segmentectomy: n = 46). Patients in the lobectomy group had a higher rate of pathologic nodal upstaging (17% versus 7%, p = 0.085) and a higher pathologic upstaging rate (38% versus 26%, p = 0.143) than the segmentectomy group. In addition, the lobectomy group had a higher number of resected lymph nodes than the segmentectomy group (median lymph nodes resected: 14 versus 7, p < 0.001). No differences were found in in 5-year recurrence-free survival (RFS; 72% versus 69%, p = 0.679) or in 5-year cancer-specific survival (CSS; 92% versus 83%, p = 0.557) between patients who underwent lobectomy or segmentectomy, respectively. CONCLUSIONS: Our data show that lobectomy and segmentectomy are comparable oncologic procedures for patients with carefully staged cT1 N0 lung adenocarcinoma with hypermetabolic tumors (SUVmax ≥ 3g/dL). Although lobectomy was associated with a more thorough lymph node dissection, this did not translate into a higher rate of RFS or CSS compared with segmentectomy.
Authors: Jiaqi Zhang; Wenliang Bai; Chao Guo; Lei Liu; Guige Wang; Cheng Huang; Yeye Chen; Ye Zhang; Shanqing Li Journal: Cancer Manag Res Date: 2020-10-01 Impact factor: 3.989
Authors: Giulia Veronesi; David R Baldwin; Claudia I Henschke; Simone Ghislandi; Sergio Iavicoli; Matthijs Oudkerk; Harry J De Koning; Joseph Shemesh; John K Field; Javier J Zulueta; Denis Horgan; Lucia Fiestas Navarrete; Maurizio Valentino Infante; Pierluigi Novellis; Rachael L Murray; Nir Peled; Cristiano Rampinelli; Gaetano Rocco; Witold Rzyman; Giorgio Vittorio Scagliotti; Martin C Tammemagi; Luca Bertolaccini; Natthaya Triphuridet; Rowena Yip; Alexia Rossi; Suresh Senan; Giuseppe Ferrante; Kate Brain; Carlijn van der Aalst; Lorenzo Bonomo; Dario Consonni; Jan P Van Meerbeeck; Patrick Maisonneuve; Silvia Novello; Anand Devaraj; Zaigham Saghir; Giuseppe Pelosi Journal: Cancers (Basel) Date: 2020-06-24 Impact factor: 6.639
Authors: Vignesh Raman; Oliver K Jawitz; Soraya L Voigt; Kristen E Rhodin; Thomas A D'Amico; David H Harpole; Chi-Fu Jeffrey Yang; Betty C Tong Journal: Chest Date: 2020-07-08 Impact factor: 9.410