PURPOSE: There is a need to further characterize the impact of sublobar resection on early-stage non-small cell lung cancer (NSCLC). In other centers, excellent outcomes have been obtained using this approach. Our objectives were to compare outcomes between lobectomy and segmentectomy for NSCLC, and to evaluate the safety of thoracoscopic techniques.
METHODS: The records of all NSCLC patients who underwent a thoracoscopic anatomic resection between 2000 and 2005 were reviewed. Overall survival and recurrence data were obtained using our prospective tumor board registry.
RESULTS: VATS anatomic resection was performed in 101 patients (lobectomy = 65; segmentectomy = 36). Most patients had early-stage NSCLC (1A=44%, 1B=38%). Brachytherapy implants were used in 39% of segmentectomies. Lobectomy patients were younger (67.9 versus 72.3 years) and had a better pre-operative FEV1 (76% versus 67% predicted). There was no significant difference in preoperative comorbidities, length of stay, complication rate (lobectomy = 27%; segmentectomy = 41%), or postoperative mortality between lobectomy and segmentectomy patients. Postoperative 30-day mortality was 2%. Mean follow up was 11.4 months. The recurrence rate was 10.6% overall with no significant difference between groups (lobectomy = 9.7%; segmentectomy = 12.5%). Overall mortality was similar between groups (lobectomy = 9.7%; segmentectomy = 13. 8%). There was no difference in local recurrence in segmentectomies which received adjuvant brachytherapy.
CONCLUSION: At early follow-up, thoracoscopic segmentectomy can be performed safely without compromising oncologic outcomes in patients with comorbidities and limited pulmonary function.
CLINICAL IMPLICATIONS: The above results suggest that minimally invasive anatomic pulmonary resections can be performed safely. In addition, a larger proportion of lung cancer patients, including those with limited pulmonary function, may be eligible for surgical therapy if minimally invasive, parenchymal sparing, surgical techniques result in oncologic outcomes comparable to standard lobectomy.
DISCLOSURE: Sebastien Gilbert, No Financial Disclosure Information; No Product/Research Disclosure Information