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Comparative Study
. 2014 Oct;148(4):1186-1192.e3.
doi: 10.1016/j.jtcvs.2014.03.019. Epub 2014 Mar 20.

Clinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases

Bo Deng  1 , Stephen D Cassivi  2 , Mariza de Andrade  3 , Francis C Nichols  2 , Victor F Trastek  2 , Yi Wang  4 , Jason A Wampfler  3 , Shawn M Stoddard  5 , Dennis A Wigle  2 , Robert K Shen  2 , Mark S Allen  2 , Claude Deschamps  2 , Ping Yang  6
Affiliations
Comparative Study

Clinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases

Bo Deng et al. J Thorac Cardiovasc Surg. 2014 Oct.

Abstract

Objective: We compared the clinical outcomes and changes in pulmonary function test (PFT) results after segmentectomy or lobectomy for non-small cell lung cancer.

Methods: The retrospective study included 212 patients who had undergone segmentectomy (group S) and 2336 patients who had undergone lobectomy (group L) from 1997 to 2012. The follow-up and medical record data were collected. We used all the longitudinal PFT data within 24 months postoperatively and performed linear mixed modeling. We analyzed the 5-year overall and disease-free survival in stage IA patients. We used propensity score case matching to minimize the bias due to imbalanced group comparisons.

Results: During the perioperative period, 1 death (0.4%) in group S and 7 (0.3%) in group L occurred. The hospital stay for the 2 groups was similar (median, 5.0 vs 5.0 days; range, 2-99 vs 2-58). The mean overall and disease-free survival period of those with T1a after segmentectomy or lobectomy seemed to be similar (4.2 vs 4.5 years, P=.06; and 4.1 vs 4.4 years, P=.07, respectively). Compared with segmentectomy, lobectomy yielded marginally significantly better overall (4.4 vs 3.9 years, P=.05) and disease-free (4.1 vs 3.6 years; P=.05) survival in those with T1b. We did not find a significantly different effect on the PFTs after segmentectomy or lobectomy.

Conclusions: Both surgical types were safe. We would advocate lobectomy for patients with stage IA disease, especially those with T1b. A retrospective study with a large sample size and more detailed information should be conducted for PFT evaluation, with additional stratification by lobe and laterality.

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Figures

Figure 1
Figure 1. Proportions of surgery types of 2509 cases, 1997-2012, Mayo Clinic (Minnesota)
Figure 2
Figure 2
There was no significant difference of the trend of postoperative PFT data, i.e., FEV1, FVC and DLCO following segementectomy or lobectomy. A: FEV1; B: FVC; and C: DLCO
Figure 3
Figure 3. Overall survival and disease free survival of T1a and T1b cases after segmentectomy or lobectomy
Note: A and B: There was no significant difference on overall survival and disease free survival of cases of T1a after segmentectomy or lobectomy, respectively; C and D: There was marginally significant difference on overall survival and disease free survival of cases of T1b after segmentectomy or lobectomy, respectively.
See this image and copyright information in PMC

References

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