COUNTERPOINT: Should Segmentectomy Rather Than Lobectomy Be the Operation of Choice for Early-Stage Non-small Cell Lung Cancer? No

Bertolaccini, Luca; Solli, Piergiorgio

doi:10.1016/j.chest.2017.10.037

Cited by 8 publications

(2 citation statements)

References 19 publications

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“…However, the lobectomy group reported more deaths due to other diseases, and the local recurrence rate of the segmentectomy group was significantly higher than that of the lobectomy group. Some studies ( 15 - 18 ) have shown lobectomy has a survival advantage over segmentectomy for stage IA NSCLC, especially tumors 2–3 cm in size ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of segmentectomy vs. lobectomy for stage IA non-small cell lung cancer

Dai,

Hu,

Shen

et al. 2023

J Thorac Dis

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Background Whether segmentectomy is appropriate for stage IA non-small cell lung cancer (NSCLC), especially for stage IA NSCLC with a tumor size of 2–3 cm, remains controversial. Thus, we conducted this meta-analysis to compare segmentectomy and lobectomy for stage IA NSCLC with a tumor size of 2–3 cm and IA ≤2 cm NSCLC. Methods A systematic screening of online databases (PubMed, Embase, Web of Science, and Cochrane Library) was conducted regarding the terms of perioperative outcomes, overall survival (OS), recurrence-free survival (RFS), and disease-free survival (DFS). The inverse-variance and Mantel-Haenszel approaches were used to pool effect sizes for survival outcomes and perioperative outcomes. Results A total of 10 articles were included in the analysis. The perioperative morbidity [risk ratio (RR): 0.90, P=0.10], mortality (RR: 0.94, P=0.84), intraoperative blood loss [mean difference (MD): 3.07, P=0.86] and operative time (MD: 18.99, P=0.13) were comparable between the segmentectomy and lobectomy groups. The number of lymph nodes harvested was statistically less in segmentectomy than in lobectomy (MD: −5.71, P=0.02). In stage IA patients with a tumor size of 2–3 cm, lobectomy showed superior survival outcomes compared to segmentectomy, with a pooled hazard ratio (HR) of 1.39 (P=0.01) for OS and 1.38 (P=0.06) for RFS or DFS. In stage IA ≤2 cm, lobectomy and segmentectomy had comparable survival outcomes with pooled HRs of 1.18 (P=0.29) for OS and 1.18 (P=0.12) for RFS or DFS. Conclusions When a patient is in stage IA and the tumor size is less than 2 cm, segmentectomy should be performed. If the tumor size is between 2 and 3 cm, lobectomy is recommended.

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Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of segmentectomy vs. lobectomy for stage IA non-small cell lung cancer

Dai,

Hu,

Shen

et al. 2023

J Thorac Dis

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“…Drs Bertolaccini and Solli report some important considerations suggesting caution in the use of segmentectomy as the operation of choice for early-stage lung cancer. 1 From a functional point of view, they maintain that the advantage related to segmental resection is present only in the preliminary period after surgery and to a lesser extent than expected.…”

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confidence: 99%