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. 2024 Jul 1;66(1):ezae251.
doi: 10.1093/ejcts/ezae251.

Real-world outcomes of lobectomy, segmentectomy and wedge resection for the treatment of stage c-IA lung carcinoma

Pascal Alexandre Thomas  1 , Agathe Seguin-Givelet  2 , Pierre-Benoît Pages  3 , Marco Alifano  4 , Laurent Brouchet  5 , Pierre-Emmanuel Falcoz  6 , Jean-Marc Baste  7 , Matthieu Glorion  8 , Yaniss Belaroussi  9 , Marc Filaire  10 , Maxime Heyndrickx  11 , Anderson Loundou  12 , Alex Fourdrain  1 , Marcel Dahan  5 , Laurent Boyer  12 ; EPITHOR working group
Collaborators, Affiliations

Real-world outcomes of lobectomy, segmentectomy and wedge resection for the treatment of stage c-IA lung carcinoma

Pascal Alexandre Thomas et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: To determine safety and survival outcomes associated with lobectomy, segmentectomy and wedge resection for early-stage lung cancer by quiring the French population-based registry EPIdemiology in THORacic surgery (EPITHOR).

Methods: Retrospective analysis of 19 452 patients with stage c IA lung carcinoma who underwent lobectomy, segmentectomy or wedge resection between 2016 and 2022 with curative-intent. Main outcome measures were 90-day mortality and 5-year overall survival estimates. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patient, tumour and practice environment factors.

Results: The treatment distribution was 72.2% for lobectomy, 21.5% for segmentectomy and 6.3% for wedge. Unadjusted 90-day mortality rates were 1.6%, 1.2% and 1.1%, respectively (P = 0.10). Unadjusted 5-year overall survival estimates were 80%, 78% and 70%, with significant inter-group survival curves differences (P < 0.0001). Multivariable proportional hazards regression showed that wedge was associated with worse overall survival [adjusted hazard ratio (AHR), 1.23 (95% confidence interval 1.03-1.47); P = 0.021] compared with lobectomy, while no significant difference was disclosed when comparing segmentectomy to lobectomy (1.08 [0.97-1.20]; P = 0.162). The three-way propensity score analyses confirmed similar 90-day mortality rate for wedge resection and segmentectomy compared with lobectomy (hazard ratio: 0.43; 95% confidence interval 0.16-1.11; P = 0.081 and 0.99; 0.48-2.10; P = 0.998, respectively), but poorer overall survival (1.45; 1.13-1.86; P = 0.003 and 1.31; 1-1.71; P = 0.048, respectively).

Conclusions: Wedge resection was associated with comparable 90-day mortality but lower overall survival when compared to lobectomy. Overall, all types of sublobar resections may not offer equivalent oncologic effectiveness in real-world settings.

Keywords: Lung carcinoma; Lymphadenectomy; Stage cIA; Sublobar resection.

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