SESSION TYPE: Thoracic Surgery II
PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM
PURPOSE: Sublobar resection is re-emerging as an alternative to lobectomy in the management of small, early-stage non-small cell lung cancers. However, the potential advantages of thoracoscopic segmentectomy compared to thoracoscopic lobectomy remained undefined. We hypothesize that thoracoscopic segmentectomy has comparable peri-operative morbidity profiles when compared to thoracoscopic lobectomy in patients undergoing lung resection for clinical stage I non-small cell lung cancer.
METHODS: Patients undergoing thoracoscopic segmentectomy (n=163) or lobectomy (n=190) for clinical stage I non-small cell lung cancer were identified from a prospectively maintained single-institution database. All patients had histologically confirmed non-small cell lung cancer resected thoracoscopically. Primary outcomes included morbidity, mortality, length of hospital stay, readmission rate, as well as disease-free survival. Comparisons were performed with the Student’s t-test and Fisher’s exact test. Actuarial estimates of recurrence-free survival were performed utilizing the Kaplan-Maier method, with significance being assessed via the log rank test.
RESULTS: There were no differences in age and gender distribution between patients undergoing lobectomy and segmentectomy. Patients undergoing lobectomy had larger tumors (mean 2.5 cm vs. 1.9 cm, p<0.001). Overall morbidity (36.8% vs. 31.9%), mortality (0.5% vs. 0.6%), length of hospital stay (5 vs. 6 days), 30-day readmission rate (7.9% vs. 8.6%), as well as recurrence-free survival (58 vs. 53%) were similar between groups. The most common complication was atrial fibrillation (Segment=6.7%; Lobe=4.7%, p=0.49). The most common major complication was pneumonia (Segment=11.0%; Lobe=12.1%, p=0.87). There were no significant differences in morbidity when comparing individual segments to their corresponding lobes. Similarly, there was no significant difference in morbidity profile when comparing upper lobe vs. lower lobe resections.
CONCLUSIONS: Thoracoscopic segmentectomy has comparable perioperative outcomes and morbidity profiles when compared to thoracoscopic lobectomy in the setting of stage I non-small cell lung cancer. These findings will need to be validated by prospective randomized comparisons (CALGB 140503).
CLINICAL IMPLICATIONS: Thoracoscopic segmentectomy can be performed with acceptable oncologic and morbidity outcomes for clinical stage I non-small cell lung cancer.
DISCLOSURE: The following authors have nothing to disclose: Nikiforos Ballian, Matthew Schuchert, David Wilson, Daniel Normolle, Joshua Landreneau, Andre Pitanga, Jamilly Gomes, Felipe Franca, Ghulam Abbas, Omar Awais, Neil Christie, James Luketich, Rodney Landreneau
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