Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: Propensity score–matched analysis in a multicenter study

Tsutani, Yasuhiro; Miyata, Yoshihiro; Nakayama, Haruhiko; Okumura, Sakae; Adachi, Shuji; Yoshimura, Masahiro; Okada, Morihito

doi:10.1016/j.jtcvs.2013.02.008

Cited by 158 publications

(105 citation statements)

References 18 publications

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“…In this study, according to postoperative measurement, the tumors resected in the segmentectomy group had smaller diameters than those in the lobectomy group; similar findings have been reported by others both in China and other countries (18,19). Because this study was retrospective and there were no standardized guidelines for selecting the procedure, individual surgeons decided which patients would undergo anatomic segmentectomy, which may have skewed the results.…”

Section: Discussionsupporting

confidence: 82%

“…Additionally, only few inter-lobar fissures need to be incised to provide an adequate field of vision, the lung lobe structure and position do not change markedly, more of the tissue in the affected lung lobe can be left in situ, and the recruitment maneuver is unnecessary: unlike lobectomy, anatomic segmentectomy does not require a maneuver to recruit other lung lobes on the affected side to fill the residual cavity. Other studies (19,20) have reported that S-VATS anatomic segmentectomy is associated with a more rapid postoperative recovery.…”

Section: Discussionmentioning

confidence: 91%

“…Previous studies (19,20) comparing the treatment outcomes of anatomic segmentectomy and lobectomy have reported that anatomic segmentectomy involves a longer operation time, fewer lymph node groups and mediastinal lymph nodes dissected, smaller postoperative drainage volume, shorter duration of postoperative drainage, and use of more staples than lobectomy. However, in our study, we found no statistically significant differences between S-VATS anatomic segmentectomy and S-VATS lobectomy in operation time, intraoperative blood loss, or number of staples used (P>0.05); S-VATS anatomic segmentectomy did not increase the number of staples used or the cost.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study

Lin¹,

Zheng²,

Guo³

et al. 2016

J. Thorac. Dis.

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Background: There are few reports of single-port video-assisted thoracoscopic surgery (S-VATS) anatomic segmentectomy and S-VATS lobectomy for early-stage non-small cell lung cancer (NSCLC) and no comparisons between them have yet been reported. Therefore, the aim of this study was to compare the safety and efficacy of S-VATS anatomic segmentectomy and S-VATS lobectomy for early-stage NSCLC.Methods: In this retrospective observational study, the outcomes of 79 consecutive patients who had undergone S-VATS anatomic segmentectomy (32 patients) or S-VATS lobectomy (47 patients) for earlystage NSCLC from April 2014 to June 2015 were examined. The operation time, intraoperative blood loss, numbers of dissected lymph nodes and mediastinal nodal stations, numbers of staples used, postoperative drainage volume and duration, duration of hospital stay, costs, postoperative complications, local recurrence, and survival were compared between these two groups.Results: The postoperative drainage volume was smaller and the postoperative drainage duration shorter in the S-VATS segmentectomy than the lobectomy group (P<0.05). There were no significant differences in operation time, intraoperative blood loss, number of staples used, number and stations of dissected mediastinal lymph nodes, duration of hospital stay, costs, or postoperative complications. At the time of writing, no deaths or local recurrences had occurred in either group.Conclusions: S-VATS segmentectomy is as safe and effective as S-VATS lobectomy. Patients who undergo S-VATS segmentectomy seem to recover faster. in local tumor recurrence rate and total 5-year survival rate between these two surgical options (5-7). Anatomic segmentectomy is clearly the less invasive. The Non-small Cell Lung Cancer Clinical Practice Guidelines issued by the National Comprehensive Cancer Network in 2010 recommend anatomic segmentectomy as a suitable operative procedure for treating early-stage non-small cell lung cancer (NSCLC) (8). The size and number of operative incisions can be used as an index of the severity of operative wounds (9,10). In accordance with the above data, surgeons have gradually begun to attempt single-port video-assisted thoracoscopic surgery (S-VATS), which is less invasive than previously performed procedures. Although Gonzalez et al. have reported outcomes of S-VATS lobectomy (11) and anatomic segmentectomy (12) and Zhu et al. have reported the comparison of the feasibility and safety between singleport and triple-port complete thoracoscopic lobectomy for NSCLC (13), there are few reports comparing S-VATS anatomic segmentectomy and lobectomy for early stage NSCLC.In this study we retrospectively analyzed data on 32 patients who had undergone S-VATS anatomic segmentectomy and 47 patients who had undergone S-VATS lobectomy for early stage NSCLC in our institution and explored the safety, efficacy, advantages, and disadvantages of these two operative procedures. MethodsIn this study, data for 79 patients who had undergone S-VATS procedures [32 anatomic segment...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study

Lin¹,

Zheng²,

Guo³

et al. 2016

J. Thorac. Dis.

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“…Focal fibrosis [5] Follicular lymphocytic bronchiolitis [3] Inflammation, nonspecific [1] Mucoid plug [1] Hamartoma [1] Focal subpleural fibroelastosis [1] Amyloid nodule [1] Metastatic lung tumour (n=65)…”

Section: From Marking To Mappingmentioning

confidence: 99%

“…It is increasingly clear that segmentectomies provide comparable outcomes to lobectomies for earlystage lung cancers, particularly in those with ground-glass nodules (GGNs) (5,6). In contrast, a potential challenge…”

Section: Introductionmentioning

confidence: 99%

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Sato¹,

Murayama²,

Nakajima³

2016

J. Thorac. Dis.

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Anatomical segmentectomies play an important role in oncological lung resection, particularly for ground-glass types of primary lung cancers. This operation can also be applied to metastatic lung tumors deep in the lung. Virtual assisted lung mapping (VAL-MAP) is a novel technique that allows for bronchoscopic multi-spot dye markings to provide "geometric information" to the lung surface, using three-dimensional virtual images. In addition to wedge resections, VAL-MAP has been found to be useful in thoracoscopic segmentectomies, particularly complex segmentectomies, such as combined subsegmentectomies or extended segmentectomies. There are five steps in VAL-MAP-assisted segmentectomies: (I) "standing" stitches along the resection lines; (II) cleaning hilar anatomy; (III) confirming hilar anatomy; (IV) going 1 cm deeper; (V) step-by-step stapling technique. Depending on the anatomy, segmentectomies can be classified into linear (lingular, S6, S2), V-or U-shaped (right S1, left S3, S2b + S3a), and three dimensional (S7, S8, S9, S10) segmentectomies. Particularly three dimensional segmentectomies are challenging in the complexity of stapling techniques. This review focuses on how VAL-MAP can be utilized in segmentectomy, and how this technique can assist the stapling process in even the most challenging ones.

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Comparison of Survival After Mohs Micrographic Surgery vs Wide Margin Excision for Early-Stage Invasive Melanoma

et al. 2019

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IMPORTANCE Melanoma is among the most common malignant neoplasms in the United States, with 91 270 cases estimated to be diagnosed in 2018. Since 2012, Mohs micrographic surgery (MMS) has gained popularity in the treatment of melanoma in situ. Although current guidelines for invasive melanoma without nodal metastases recommend surgery with wide margin excision (WME), use of MMS for this disease has increased as well, particularly in early stages. How the survival outcomes after each procedure compare with one another for early-stage invasive melanoma is unknown to date. OBJECTIVE To evaluate overall survival of patients with stage I melanoma defined by the American Joint Committee on Cancer Cancer Staging Manual, 8th edition (AJCC-8) after MMS vs traditional WME. DESIGN, SETTING, AND ANALYSIS This retrospective cohort study includes all patients with AJCC-8 stage I melanoma who underwent MMS or WME in the National Cancer Database with a diagnosis from January 1, 2004, through December 31, 2014. The National Cancer Database includes all reportable cases from Commission on Cancer-accredited facilities and represents approximately 50% of all newly diagnosed melanoma cases in the United States. Data were analyzed from November 13, 2018, through June 9, 2019. EXPOSURES MMS vs WME. MAIN OUTCOMES AND MEASURES Overall survival evaluated using multivariable Cox proportional hazards regression analysis. RESULTS A total of 70 319 eligible patients (52.3% male and 47.7% female; median [SD] age, 57.0 [16.2] years) were identified, including 67 085 treated with WME and 3234 treated with MMS. Multivariable Cox proportional hazards regression survival analysis controlling for clinical and tumor factors revealed that treatment with MMS was associated with a modest improvement in overall survival relative to WME (hazard ratio [HR], 0.86; 95% CI, 0.76-0.97). Propensity score-matched analysis of cohorts of patients treated with MMS vs WME also found modestly improved survival for those treated with MMS (HR, 0.82; 95% CI, 0.68-0.98). Academic facilities were more likely to use MMS than nonacademic facilities (odds ratio, 2.03; 95% CI, 1.88-2.18). CONCLUSIONS AND RELEVANCE These findings suggest that Mohs surgery may provide an alternative approach to traditional WME for appropriately selected cases of AJCC-8 stage I melanoma without compromising patient survival.

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Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: Propensity score–matched analysis in a multicenter study

Abstract: Segmentectomy is suitable for clinical stage IA lung adenocarcinoma, with survivals equivalent to those of standard lobectomy.

Cited by 158 publications

References 18 publications

Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study

Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Comparison of Survival After Mohs Micrographic Surgery vs Wide Margin Excision for Early-Stage Invasive Melanoma

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