Haihua Zhang1, Chen Liu2, Zhijun Tan3, Tao Zhang4. 1. Department of Thoracic Surgery, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China. 2. Department of Anesthesiology, the Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China. 3. Department of Statistics, Basic Medical College of Air Force Medical University, Air Force Medical University, Xi'an, China. 4. Department of Thoracic Surgery, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China. Electronic address: zhangft@fmmu.edu.cn.
Abstract
BACKGROUND: Segmentectomy and wedge resection have been recommended as appropriate surgical treatments for patients with poor pulmonary function or major comorbidities. However, for stage I non-small cell lung cancer (NSCLC), it is still undecided whether survival is better with segmentectomy or with wedge resection. METHODS: A meta-analysis was performed of studies examining survival outcomes after sublobar resection in patients with stage I NSCLC. Three electronic databases were searched to identify studies that investigated overall survival, cancer-specific survival, and disease-free survival between patients receiving segmentectomy versus wedge resection. A total of 19 relevant studies published before 31 April 2018 that satisfied the inclusion criteria were included in this meta-analysis. RESULTS: The 19 studies involved a total of 14,197 patients with stage I NSCLC. Overall survival was significantly better after segmentectomy than after wedge resection (hazard ratio [HR] = 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.00001). This was also true of cancer-specific survival (HR = 0.71; 95% CI, 0.64-0.79; P < 0.00001) and disease-free survival (HR = 0.73, 95% CI, 0.54-0.98; P = 0.04). A fixed-model was applied for the analysis as there was no significant heterogeneity between the studies. CONCLUSIONS: Survival after lobar resection for stage I NSCLC is significantly better with segmentectomy than with wedge resection.
BACKGROUND: Segmentectomy and wedge resection have been recommended as appropriate surgical treatments for patients with poor pulmonary function or major comorbidities. However, for stage I non-small cell lung cancer (NSCLC), it is still undecided whether survival is better with segmentectomy or with wedge resection. METHODS: A meta-analysis was performed of studies examining survival outcomes after sublobar resection in patients with stage I NSCLC. Three electronic databases were searched to identify studies that investigated overall survival, cancer-specific survival, and disease-free survival between patients receiving segmentectomy versus wedge resection. A total of 19 relevant studies published before 31 April 2018 that satisfied the inclusion criteria were included in this meta-analysis. RESULTS: The 19 studies involved a total of 14,197 patients with stage I NSCLC. Overall survival was significantly better after segmentectomy than after wedge resection (hazard ratio [HR] = 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.00001). This was also true of cancer-specific survival (HR = 0.71; 95% CI, 0.64-0.79; P < 0.00001) and disease-free survival (HR = 0.73, 95% CI, 0.54-0.98; P = 0.04). A fixed-model was applied for the analysis as there was no significant heterogeneity between the studies. CONCLUSIONS: Survival after lobar resection for stage I NSCLC is significantly better with segmentectomy than with wedge resection.