Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with Stage I non-small cell lung cancer: a systematic review and meta-analysis

Wang, Huanhuan; Zhang, Chun-Ze; Zhang, Bai-Lin; Chen, Jie; Zeng, Xianliang; Deng, Lei; Meng, Maobin

doi:10.18632/oncotarget.14010

Cited by 21 publications

(14 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since the National Lung Screening Trial approved the use of low-dose computed tomography for lung cancer screening, this method has become popular in the population and an increasing number of early stage non-small cell lung cancer (NSCLC) cases have been diagnosed [ 2 ]. Radical lobectomy is the gold standard for treating early stage lung cancer, although, with the refinement of lung cancer stage definition, sublobar resection has become gradually suitable for partial ≤2-cm lung adenocarcinoma [ 3 – 6 ]. In addition, sublobar resection is an important tool because it assists in the diagnosis of suspicious malignant pulmonary nodules.…”

Section: Introductionmentioning

confidence: 99%

Optimal margins for early stage peripheral lung adenocarcinoma resection

et al. 2021

View full text Add to dashboard Cite

Background A pathologically confirmed negative margin is required when performing sublobar resection in patients with early stage peripheral lung adenocarcinoma. However, the optimal margin distance to ensure complete tumor resection while preserving healthy lung tissue remains unknown. We aimed to establish a reliable distance range for negative margins. Methods A total of 52 intraoperative para-cancer tissue specimens from patients with peripheral lung adenocarcinoma with pathological tumors ≤2 cm in size were examined. Depending on the distance from the tumor edge (D), the para-cancer tissues were divided into the following five groups: D < 0.5 cm (group I); 0.5 cm ≤ D < 1.0 cm (group II); 1.0 cm ≤ D < 1.5 cm (group III); 1.5 cm ≤ D < 2.0 cm (group IV); and D ≥ 2.0 cm (group V). During pathological examination of the specimens under a microscope, the presence of atypical adenomatous hyperplasia or more severe lesions was considered unsafe, whereas the presence of normal lung tissue or benign hyperplasia was considered safe. Results Group V, in which the margin was the farthest from the tumor edge, was the safest. There were significant safety differences in between groups I and V (χ2 = 26.217, P < 0.001). Significant safety differences also existed between groups II and V (χ2 = 9.420, P < 0.005). There were no significant safety differences between group III or IV and group V (P = 0.207; P = 0.610). Conclusions We suggest that when performing sublobar resection in patients with early stage peripheral lung adenocarcinoma with pathological tumor sizes ≤2 cm, the resection margin distance should be ≥1 cm to ensure a negative margin.

show abstract

Section: Introductionmentioning

confidence: 99%

Optimal margins for early stage peripheral lung adenocarcinoma resection

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although, the current gold standard surgical procedure for NSCLC is still lobectomy (3,4), sublobar resection (SLR) which includes wedge resection and segmentectomy have been reported to be effective by GGOs (ground-glass opacities) (5)(6)(7)(8). Further, SLR is recommended for earlystage NSCLC patients with low tolerance for lobectomy (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

The surgical management of early-stage lung adenocarcinoma: is wedge resection effective?

Bai

Qiu

et al. 2021

J Thorac Dis

View full text Add to dashboard Cite

Background: The aim of the study was to explore the outcomes of wedge resection on patients with earlystage lung adenocarcinoma (LUAD) and further identify potential prognostic factors for these patients.Methods: A retrospective cohort of 190 patients (99 solitary LUAD and 91 multifocal LUAD) undergone wedge resection from October 2014 to September 2015 was established. Cox proportional-hazards model was used to evaluate the significant clinical prognostic factors. Further, data on patients with multifocal adenocarcinoma after segmentectomy were retrieved and propensity score matching was used to compare the outcomes of patients with multiple pulmonary nodules (MPNs) after wedge resection and segmentectomy. Results:The 5-year overall survival (OS), progression-free survival (PFS), and lung cancer specific survival of the 190 patients after wedge resection were 95.5%, 87.9%, and 97.7%, respectively. Multivariable analysis showed that MPN [hazard ratio (HR) 3.07; 95% confidence interval (CI), 1.05-8.98] and solid-dominant lesions (HR 15.87; 95% CI, 2.38-105.84) were independently associated with worse PFS. Further, propensity score matching analysis showed that MPN patients had better PFS after segmentectomy compared with wedge resection (94% vs. 80.9%, P=0.008). MPN patients were more likely to perform systematic mediastinal nodal sampling (95.6% vs. 59.3%, P<0.001) after segmentectomy compared to patients who underwent wedge resection. Conclusions: Wedge resection is a practical option for appropriately selected early-stage LUAD where tumor size is less than 2 cm and has a consolidation-to-tumor ratio ≤0.5. However, for MPNs, wedge resection may be not reliable and alternative procedures such as segmentectomy should be used.

show abstract

“…7 Surgery has even been shown to demonstrate an increase in survival compared with radiotherapy in this cohort. 8 Age itself is not a contraindication for surgery, nor should it be, although it is understood that it can be a marker of decreased physiological and mental compliance, often proportional to comorbidities. 9 Physiological decline, multimorbidity, and frailty are independent predictors that are associated with aging.…”

Section: Introductionmentioning

confidence: 99%

Elective Lung Resections in the Elderly: Where Do We Draw the Line?

Smelt

Lovejoy

Thakker

et al. 2020

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Introduction The increasing longevity of the Western population means patients with a more advanced age are being diagnosed with resectable disease. With improvements in imaging and diagnostic capabilities, this trend is likely to develop further. As a unit operating on a higher proportion of older patients and with limited literature regarding the population of older than 85 years, we retrospectively compared the outcomes of patients older than 85 years in our unit treated with elective lung resection for non-small cell lung cancer (NSCLC) with those between the age of 80 and 84 years inclusive. Methods All patients who underwent elective lung cancer resection between the years 2012 and 2015 were identified from the National Thoracic Surgical Database. Results A total of 701 elective lung resections were performed during this time frame; 76 patients between the ages of 80 and 84 years and 18 patients older than 85 years. The follow-up period was 3 to 7 years. There was a significant increase in the Thoracic Surgery Scoring System (2.04; 2.96%, p = 0.0015) and a significant reduction in the transfer factor (94.7; 69.5%, p = 0.0001) between the younger and older groups. There were three (3.9%) in-hospital deaths in the 80 to 84 years age group and no in-hospital deaths in the 85 years and older age group. Conclusion This study demonstrates that surgery for early NSCLC can be safely performed in 85 years and older population. This is a higher risk population and parenchymal-sparing procedures should be considered.

show abstract

Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with Stage I non-small cell lung cancer: a systematic review and meta-analysis

Cited by 21 publications

References 58 publications

Optimal margins for early stage peripheral lung adenocarcinoma resection

Optimal margins for early stage peripheral lung adenocarcinoma resection

The surgical management of early-stage lung adenocarcinoma: is wedge resection effective?

Elective Lung Resections in the Elderly: Where Do We Draw the Line?

Contact Info

Product

Resources

About