Meta-analysis of segmentectomy versus wedge resection in stage IA non-small-cell lung cancer

Abstract

BackgroundAlthough limited resection was once considered the surgical treatment for patients with Phase IA non-small-cell lung cancer (NSCLC), there has been an ongoing controversial surgical indication for wedge resection and segmentectomy in recent years. The objective of this study was to compare overall survival (OS) and disease-free survival (DFS) of segmentectomy and wedge resection for early stage NSCLC, using a meta-analysis.MethodsSystematic research was conducted using four online databases to search for studies published before 2017. The DFS and OS for early stage NSCLC after segmentectomy and wedge resection were compared. The studies were selected according to rigorous predefined inclusion criteria, and meta-analyzed using the log (hazard ratio; ln[HR]) and its standard error (SE) calculations.ResultsIncluded in this meta-analysis were nine studies, published from 2006 to 2017, with a total of 7,272 patients. Survival outcome of segmentectomy was comparable to wedge resections for stage IA lung cancer because of OS (similar hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.83–1.05, P=0.26) and DFS (similar HR: 0.81, 95% CI: 0.60–1.09, P=0.17). Nevertheless, for stage IA NSCLC with tumor size ≤2 cm, segmentectomy was superior to wedge resection (combined HR: 0.82, 95% CI: 0.70–0.97, P=0.02). However, there were no significant differences in OS rates, 1.07 (95% CI: 0.78–1.46, P=0.68), between segmentectomy and wedge resection for IA NSCLC with a tumor size of ≤1 cm.ConclusionThis study concluded that segmentectomy could achieve better OS than wedge resection for stage IA NSCLC with a tumor size of ≤2 cm. However, surgeons could conduct segmentectomy and wedge resection for NSCLC ≤1 cm according to patient profile and the location of tumor. These results should be confirmed by further randomized clinical trials.

Segmentectomy or Wedge Resection in Stage IA Lung Squamous Cell Carcinoma and Adenocarcinoma?

“…Although most patients with NSCLC are diagnosed at an advanced stage, 10%-15% of them are diagnosed with stage IA NSCLC 1 . Moreover, with the introduction of high-resolution computed tomography (CT) and low-dose helical CT screening for lung cancer, the number of patients diagnosed with early-stage lung cancer has increased 6 . Surgery is one of the most important treatment methods for stage IA NSCLC.…”

Video-assisted thoracic surgery segmentectomies: Brazilian experience

“…Some retrospective studies have demonstrated better disease-free and overall survival of patients undergoing segmentectomy compared to wedge resection, reinforcing the margin concerns in wedge resections and the theoretical oncological benefits of segmentectomy in the context of sublobar resections (18,19). A recent meta-analysis included nine studies with 7,272 patients and showed an overall survival of segmentectomy over wedge resection in tumor size ≤2 cm (20). However, the survival was equivalent in tumor size ≤1 cm.…”

Comparison Between Wedge Resection and Lobectomy/Segmentectomy for Early-Stage Non-small Cell Lung Cancer: A Bayesian Meta-analysis and Systematic Review

“…75 However, patients who underwent wedge resection showed lower complication rates than those who underwent lobectomy, and the OS of segmentectomy was superior to that of wedge resection. [76][77][78] Segmentectomy and wedge resection for patients with stage I NSCLC was compared with another meta-analysis study published in 2016. 78 The results showed that for patients with stage I NSCLC, segmentectomy results in higher survival rates than wedge resection, whereas the outcomes of wedge resection are comparable to those of segmentectomy for patients with stage Ia NSCLC with tumor size B 2 cm.…”