The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

Salazar, Michelle C.; Canavan, Maureen; Walters, Samantha L.; Chilakamarry, Sitaram; Ermer, Theresa; Blasberg, Justin D.; Yu, James B.; Gross, Cary P.

doi:10.1016/j.jtocrr.2021.100143

Cited by 4 publications

(4 citation statements)

References 46 publications

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“…These studies mostly involved open thoracotomy. The welldocumented (29) decrease in perioperative complications with VATS lobectomy in general is also noted in older patients: S3-2) (12,13,18,19,26,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). The hazard ratios (HRs) for OS and LCSS fairly consistently favor lobectomy.…”

Section: Mortality and Morbiditymentioning

confidence: 83%

“…Few adjusted NRCs address resection extent in compromised patients (Table S3-3) (38,104). Salazar et al analyzed patients with a life expectancy of ≤5 years (based on non-cancer characteristics; 67% age ≥80, 84% Elixhauser comorbidity ≥3) (38). Wedge (vs. lobectomy) was associated with worse LCSS, but fewer non-cancer deaths (90-day mortality excluded).…”

Section: Survival and Recurrencementioning

confidence: 99%

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A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors

Bade¹,

Blasberg²,

Mase³

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 (SBRT), 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 older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with 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 older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn't been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined.Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors <1 cm are not a reliably favorable group.Conclusions: A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.Review Article on A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation A detailed description of the approach is provided elsewhere (see Methods section of Part 1) (1). Briefly, the subject is stage cIA NSCLC (using the 8 th edition nomenclature t h r o u g h o u t ) . I n t e r v e n t i o n s i n c l u d e l o b e c t o m y, segmentectomy, wedge resection, SBRT and ablation. The most relevant outcomes were chosen a priori: short-term treatment-related mortality, toxicity/morbidity, ...

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Section: Mortality and Morbiditymentioning

confidence: 83%

Section: Survival and Recurrencementioning

confidence: 99%

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors

Bade¹,

Blasberg²,

Mase³

et al. 2022

J Thorac Dis

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“…This could expand the pool of patients who can potentially benefit from surgical intervention. Studies have suggested that patients undergoing less extensive lung resections tend to have better postoperative outcomes, including reduced rates of complications and improved overall survival [ 21 ]. The decision to perform a specific type of surgery should be individualized on the basis of the patient’s overall health, tumor characteristics, and response to preoperative chemo-IO.…”

Section: Podcast Transcriptmentioning

confidence: 99%

A Podcast on Pre- or Perioperative Chemoimmunotherapy for Stage III Non-Small Cell Lung Cancer: Shared Agreement from the Thoracic Surgeon and Oncologist Perspectives

Bertolaccini,

De Giglio,

Gariazzo

et al. 2024

Oncol Ther

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Management of stage II–III non-small cell lung cancer (NSCLC) has been dramatically revolutionized by studies testing the addition of immunotherapy (IO) to chemotherapy in the pre- or perioperative setting. That is because the integration of chemoimmunotherapy (chemo-IO) with surgery has consistently shown a significant improvement in pathological complete response (path CR) rate, event-free survival, and, more recently, overall survival, versus preoperative chemotherapy alone. Particularly, resectable stage III NSCLCs represent a disease entity with a high risk of distant recurrence after radical surgery, for whom pre- or perioperative chemo-IO should be considered as the preferential treatment option. However, owing to the heterogeneity of stage III NSCLC, a standard definition of resectability is not established yet, being often subjective according to the expertise and clinical background of the thoracic surgeon. In addition, careful patient selection on the basis of tumor biomarkers, meticulous staging of the disease, and accurate monitoring of treatment-related adverse events are critical factors that could prevent the ineligibility for surgery of patients treated with pre- or perioperative chemo-IO. Finally, the impact of downstaging for initially borderline resectable tumors, as well as the exact number of preoperative chemo-IO cycles needed and the indications for adjuvant IO, still need to be fully elucidated. In this podcast, we will touch upon the above-mentioned topics from the perspectives of the thoracic surgeon and the oncologist, and suggest a shared agreement between two of the main actors involved in the treatment of resectable stage III NSCLCs. Podcast audio available for this publication. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-024-00267-6.

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“…We have recently shown that the benefit of a lobectomy over a wedge resection diminishes considerably among patients with shorter life expectancy due to age and comorbidities. 28 The decision for adjuvant chemotherapy may be heavily influenced by their potential to survive long enough to derive a benefit from additional therapy. In addition, it is critical to understand the goals of care for each individual patient and not assume that all patients who might obtain a small theoretical survival benefit are willing to undergo adjuvant treatments.…”

Section: Important Notes Related To Adjuvant Therapy Changes In the Staging Systemmentioning

confidence: 99%

Role of adjuvant therapy in T1-2N0 resected non–small cell lung cancer

Woodard

Boffa

2022

The Journal of Thoracic and Cardiovascular Surgery

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The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

Cited by 4 publications

References 46 publications

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors

A Podcast on Pre- or Perioperative Chemoimmunotherapy for Stage III Non-Small Cell Lung Cancer: Shared Agreement from the Thoracic Surgeon and Oncologist Perspectives

Role of adjuvant therapy in T1-2N0 resected non–small cell lung cancer

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