Survival and Recurrence Following Wedge Resection Versus Lobectomy for Early-Stage Non-Small Cell Lung Cancer

Dolan, Daniel P.; Swanson, Scott J.; Gill, Ritu R.; Lee, Daniel N.; Mazzola, Emanuele; Kucukak, Suden; Polhemus, Emily; Bueno, Raphael; White, Augustus A.

doi:10.1053/j.semtcvs.2021.04.056

Cited by 10 publications

(12 citation statements)

References 25 publications

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“…Variability in studies of margin distance and M/T ratio (Tables 8,9) (53,(149)(150)(151)(152)(153)(154)(155)(156)(157)(158)(159)(160)(161)(162)(163)(164) likely reflects multiple factors-e.g., adjustment for confounders, proportion of unfit patients or favorable tumors, follow-up duration, resection extent (average margin 15 mm for segment vs. 8 mm for wedge in a prospective study) (165). The data loosely suggest an inflection point around 1 cm, with ~25% recurrence with <1 cm margins.…”

Section: Impact Of Resection Marginmentioning

confidence: 99%

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally healthy patients

Detterbeck¹,

Mase²,

Li³

et al. 2022

J Thorac Dis

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Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand).A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making.Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results:In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence.

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Section: Impact Of Resection Marginmentioning

confidence: 99%

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally healthy patients

Detterbeck¹,

Mase²,

Li³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…[24][25][26][27][28] More specifically, a large single-institution retrospective review found no statistically significant difference in overall survival between lobectomy and wedge resection (83.4% vs. 86.2%, p = 0.47). 24 These findings were corroborated by a systematic review (hazard ratio [HR]: 0.84, p = 0.60) 26 and a retrospective analysis of the patients who underwent surgery within the National Lung Screening Trial (71% vs. 65%, p = 0.40). 28 However, retrospective analyses of the National Cancer Database published conflicting results in 2015 and 2018, demonstrating favorable overall survival with lobectomy (99%) as compared to segmentectomy (74%) and wedge resection (68%) in 2015, 27 but comparable survivals between sublobar resection (55.6%) and lobectomy (61%) in 2018.…”

Section: Introductionmentioning

confidence: 97%

“…It was in this setting, that while many tried, few institutions could demonstrate superior survival or morbidity/mortality outcomes with sublobar resection as compared to the now standard VATS lobectomy 24–28 . More specifically, a large single‐institution retrospective review found no statistically significant difference in overall survival between lobectomy and wedge resection (83.4% vs. 86.2%, p = 0.47) 24 . These findings were corroborated by a systematic review (hazard ratio [HR]: 0.84, p = 0.60) 26 and a retrospective analysis of the patients who underwent surgery within the National Lung Screening Trial (71% vs. 65%, p = 0.40) 28 .…”

Section: Introductionmentioning

confidence: 98%

“…Between 1995 and 2010, rates of minimally invasive surgery for lung cancer skyrocketed from 3.5% to 45% 23 . It was in this setting, that while many tried, few institutions could demonstrate superior survival or morbidity/mortality outcomes with sublobar resection as compared to the now standard VATS lobectomy 24–28 . More specifically, a large single‐institution retrospective review found no statistically significant difference in overall survival between lobectomy and wedge resection (83.4% vs. 86.2%, p = 0.47) 24 .…”

Section: Introductionmentioning

confidence: 99%

“…Retrospective series from larger academic institutions and databases began to emerge, some suggesting overall and recurrence-free survival (RFS) were similar between sublobar resection and lobectomy, with data conflicting on whether or not segmentectomy and wedge resection were equivalent approaches that could be grouped en mass when compared to lobectomy. [24][25][26][27]31 So conflicting was the data, that it became apparent that defining and ensuring high-quality sublobar resection in clinical research was just as paramount to an "apples-to-apples" comparison as the lack of rib spreading was to defining VATS research a decade prior. For instance, one study indicated that up to 26% of VATS wedge resections were completed with 0 lymph nodes sampled 32 -hardly a "quality sublobar resection.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sublobar resections for lung cancer: Finally, some answers and some more questions?

Swanson

White

2023

Journal of Surgical Oncology

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CT imaging features of lung ground-glass nodule patients with upgraded intraoperative frozen pathology

Wang,

Chen,

Wang

et al. 2024

Discov Onc

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Purpose Intraoperative frozen section pathology (FS) is widely used to guide surgical strategies while the accuracy is relatively low. Underestimating the pathological condition may result in inadequate surgical margins. This study aims to identify CT imaging features related to upgraded FS and develop a predictive model. Methods Collected data from 860 patients who underwent lung surgery from January to December 2019. We analyzed the consistency rate of FS and categorized the patients into three groups: Group 1 (n = 360) had both FS and Formalin-fixed Paraffin-embedded section (FP) as non-invasive adenocarcinoma (IAC); Group 2 (n = 128) had FS as non-IAC but FP as IAC; Group 3 (n = 372) had both FS and FP as IAC. Clinical baseline characteristics were compared and propensity score adjustment was used to mitigate the effects of these characteristics. Univariate analyses identified imaging features with inter-group differences. A multivariate analysis was conducted to screen independent risk factors for FS upgrade, after which a logistic regression prediction model was established and a receiver operating characteristic (ROC) curve was plotted. Results The consistency rate of FS with FP was 84.19%. 26.67% of the patients with non-IAC FS diagnosis were upgraded to IAC. The predictive model’s Area Under Curve (AUC) is 0.785. Consolidation tumor ratio (CTR) ≤ 0.5 and smaller nodule diameter are associated with the underestimation of IAC in FS. Conclusion CT imaging has the capacity to effectively detect patients at risk of upstaging during FS.

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Survival and Recurrence Following Wedge Resection Versus Lobectomy for Early-Stage Non-Small Cell Lung Cancer

Cited by 10 publications

References 25 publications

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally healthy patients

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally healthy patients

Sublobar resections for lung cancer: Finally, some answers and some more questions?

CT imaging features of lung ground-glass nodule patients with upgraded intraoperative frozen pathology

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