Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localisation and width of resection margins — implications for patient selection for segmentectomy☆

Sienel, Wulf; Stremmel, Christian; Kirschbaum, Andreas; Hinterberger, Louisa; Stoelben, Erich; Hasse, J; Passlick, Bernward

doi:10.1016/j.ejcts.2006.12.018

Cited by 136 publications

(98 citation statements)

References 23 publications

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“…The 5-yr survival rates of their pT1N0M0 counterparts were 87.1% for extended segmentectomy and 87.8% for lobectomy (p50.8008). WARREN et al [25], KOIKE et al [28], WATANABE et al [32] and SIENEL et al [42] reported similar results in this selective group of patients with small T1 tumours.…”

Section: Tumour Sizesupporting

confidence: 70%

“…Finally, in the series of SIENEL et al [42], the cancer-related 5-yr survival rate for 150 patients who had undergone lobectomy was 83%, which was significantly higher than the 67% found in 47 patients who had undergone segmentectomy. However, again, when patients with tumours of f2 cm in diameter were considered, survival differences were not statistically significant.…”

Section: Survival and Recurrencementioning

confidence: 99%

“…The 5-yr survival rates of lobectomy and sublobar resection were equivalent, except in six studies [25,27,35,36,40,42]. WARREN et al [25] compared the survival of 103 patients who had undergone lobectomy with the survival of 66 patients who had undergone segmentectomy: 5-yr survival was significantly better for those who had undergone lobectomy (65% versus 45%).…”

Section: Survival and Recurrencementioning

confidence: 99%

“…SUBLOBAR RESECTIONS FOR SMALL SOLID AND PARTLY SOLID PERIPHERAL TUMOURS Indications Table 1 shows the most relevant data from 20 studies comparing lobectomy with sublobar resection [8,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. All but three were retrospective: one was a prospective but nonrandomised study [28] and two were prospective observational studies [20,34].…”

Section: Upper Lobementioning

confidence: 99%

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Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2009

Eur Respir J

102

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Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged .71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of f2 cm, segmentectomy is equivalent to lobectomy, but survival after segmentectomy is worse if performed for larger tumours. For both segmentectomy and wedge resection, tumour margins should be o1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of f2 cm, diagnosed intraoperatively with certainty, sublobar resection seems equivalent to lobectomy, and because there is no nodal involvement, systematic nodal dissection may not be necessary. In case of doubt, however, lobectomy with systematic nodal dissection will ensure complete resection and adequate staging. More randomised trials are needed to confirm all these issues.

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Section: Tumour Sizesupporting

confidence: 70%

Section: Survival and Recurrencementioning

confidence: 99%

Section: Survival and Recurrencementioning

confidence: 99%

Section: Upper Lobementioning

confidence: 99%

See 2 more Smart Citations

Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2009

Eur Respir J

102

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“…Recently, a large retrospective study (SEER) showed that lobectomy and segmentectomy resulted in similar survival among patients with small (,1 cm) tumours [62]. In a retrospective series, SIENEL et al [63] reported that local relapse after segmentectomy was more common in the S1-S3 region, especially when the resection margin was ,1 cm.…”

Section: Surgery For Early Stage Lung Cancer (Stage I and Ii)mentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

Eur Respir Rev

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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Intraoperative near‐infrared fluorescence imaging targeting folate receptors identifies lung cancer in a large‐animal model

Keating

Runge

Singhal

et al. 2016

Cancer

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Background Complete tumor resection is the most important predictor of patient survival from non-small cell lung cancer. Methods of intraoperative margin assessment following lung cancer excision are lacking. We evaluated near-infrared intraoperative imaging using a folate-targeted molecular contrast agent (OTL0038) for localization of primary lung adenocarcinoma, lymph node sampling, and margin assessment. Methods Ten dogs with lung cancer underwent either video-assisted thoracoscopic surgery (VATS) or open thoracotomy and tumor excision following intravenous injection OTL0038. Lungs were imaged using a NIR imaging device both in vivo and ex vivo. The wound bed was re-imaged for retained fluorescence suspicious for positive tumor margins. Tumor signal-to-background ratio (SBR) was measured in all cases. Next, three human patients were enrolled in a proof-of-principle study. Tumor fluorescence was measured both in situ and ex vivo. Results All canine tumors fluoresced in situ (Fluoptics mean SBR 5.2 (range 2.7-8.1); Karl Storz mean SBR 2.9 (range 1.4-2.6). Additionally, fluorescence was consistent with tumor margins on pathology. Three positive lymph nodes were discovered using NIR imaging. Also, a positive retained tumor margin was discovered upon NIR imaging of the wound bed. Human pulmonary adenocarcinomas were also fluorescent both in situ and ex vivo (mean SBR > 2.0). Conclusions NIR imaging identifies lung cancer in a large animal model. Additionally, NIR imaging can discriminate lymph nodes harboring cancer cells and also bring attention to a positive tumor margin. In humans, pulmonary adenocarcinomas fluoresce after injecting the targeted contrast agent.

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Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localisation and width of resection margins — implications for patient selection for segmentectomy☆

Abstract: The frequency of local recurrence following segmentectomy might be influenced by segment localisation and width of resection margins. Segmentectomy within the S1-3 region should be avoided whenever possible.

Cited by 136 publications

References 23 publications

Sublobar resection for lung cancer

Sublobar resection for lung cancer

Surgery for nonsmall cell lung cancer

Intraoperative near‐infrared fluorescence imaging targeting folate receptors identifies lung cancer in a large‐animal model

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