Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer

Shapiro, Mark; Weiser, Todd S.; Wisnivesky, Juan P.; Chin, Cynthia; Arustamyan, Michael; Swanson, Scott J.

doi:10.1016/j.jtcvs.2009.02.009

Cited by 131 publications

(95 citation statements)

References 26 publications

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“…Currently, the specific approach remains a matter of controversy. Several series suggest that there is no difference in overall survival between lobectomies performed by VATS versus those performed by thoracotomy for clinical stage I nonsmall cell lung cancer (NSCLC) [4,5]. Morbidity appears to be lower with the VATS approach.…”

Section: Surgical Approachmentioning

confidence: 99%

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Asamura²,

et al. 2011

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A new adenocarcinoma classification was recently introduced by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS). A distinction is made between pre-invasive lesions, and minimally invasive and invasive adenocarcinoma. The confusing term ''bronchioloalveolar carcinoma'' is not used any more and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma.Due to a renewed interest in screen-detected nodules and early-stage lung cancers of ,2 cm, this classification also has profound implications for thoracic surgeons.In this article, surgical topics are discussed: the role of a minimally invasive approach, especially video-assisted thoracic surgery, limited resection for early-stage lung cancer, the extent of lymph node dissection, the accuracy of intraoperative frozen section analysis, management of multiple lung nodules and prognostic factors in operated patients. Specific key issues are presented based on the current evidence and areas of surgical uncertainty are defined providing a basis for further studies.Thoracic surgeons will play a major role in the application and global introduction of this new adenocarcinoma classification. The remaining controversies regarding the precise diagnosis and management of early-stage lesions will have to be resolved by multidisciplinary and international collaboration.

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Section: Surgical Approachmentioning

confidence: 99%

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Asamura²,

et al. 2011

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“…In recent years, several retrospective reports have demonstrated that segmentectomy for small-sized (diameter ≤2.0 cm) stage Ia NSCLC may be comparable to lobectomy regarding prognosis and local recurrence (3)(4)(5). However, the clinical results of wedge resection for small-sized (diameter ≤2.0 cm) stage Ia NSCLC is still under debate (6,7).…”

Section: Introductionmentioning

confidence: 99%

Sublobar resections for small-sized stage Ia lung adenocarcinoma: a Sino-Japanese multicenter study

et al. 2018

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Background: Segmentectomy for small-sized stage Ia non-small cell lung cancer (NSCLC) may be comparable to lobectomy regarding prognosis and local recurrence. However, the clinical results of wedge resection for such patients are still under debate. In this international multicenter study, we retrospectively studied surgical outcomes of sublobar resections for patients with small-sized stage Ia adenocarcinoma to elucidate whether wedge resection is inferior to segmentectomy for such patients.Methods: Between March 2000 and August 2011, 173 patients underwent segmentectomy (group I), and 181 patients underwent wedge resection (group II) at three institutions in Japan and China. The tumor was defined as Ground glass opacity (GGO) type when the proportion of GGO was equal or more than 50% in HRCT, while solid type was defined as the proportion of GGO less than 50%. Clinicopathologic factors, local recurrence rate, and survival were compared. Results:The two groups were similar in sex, comorbidity rate, and composition of Noguchi type. There was no in-hospital death. Postoperative morbidity rate of group I was significantly higher than that of group II (11.0% vs. 2.2%, P=0.016). Local recurrence rates were similar between group I (4.0%) and group II (4.4%), while no patient with GGO type tumors had local recurrence. Overall and lung cancer-specific survivals were of no significant difference between the two groups. Lung cancer-specific survival rates at 10 years were significantly better in patients with GGO type tumors than in those with solid type tumors (100% vs. 76.9%, P<0.001). In multivariate Cox regression analyses of lung cancer-specific survival of all patients, GGO type turned out to be an independent prognostic factor, while extent of resection did not have any influence.Conclusions: Our data suggests that sublobar resection is an acceptable procedure for small lung adenocarcinomas without nodal involvement, and wedge resection may not be inferior to segmentectomy for small GGO type tumors. Our study also demonstrates that GGO type is an independent prognostic factor of disease-free survival for small-sized (diameter ≤2.0 cm) stage Ia lung adenocarcinomas.

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“…This ability has led to many surgeons re-examining their stance on the extent of surgical resections (i.e., sublobar resections) or malignant disease processes. However, the role of parenchymal-sparing operations such as segmentectomy in the treatment of T1a lung carcinoma, is still of much debate, in part because of the retrospective nature of existing published studies (7)(8)(9). Two randomized control trials however, both of which have currently finished enrollment, will hopefully shed further light on this topic (10,11).…”

Section: Introductionmentioning

confidence: 99%

T1a lung carcinoma: the place of segmentectomy in the treatment array

Hirji¹,

Swanson²

2018

J. Thorac. Dis.

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Contemporary management of early stage non-small cell lung cancer (NSCLC) is evolving and can be attributed to a change in size and histology of lung cancer, advancements in imaging modalities, instrumentation and surgical techniques. The emergence of segmentectomy has further challenged the existing treatment landscape, with promising results. Despite limited widespread adoption, video-assisted thoracoscopic surgery (VATS) segmentectomy is a safe option in the treatment of patients with small stage I lung cancers, with excellent oncologic results and improved morbidity relative to open techniques. In this paper, we critically examine the utility of segmentectomy, and the emerging role of VATS, including technical tips and tricks, in the management of T1a lung carcinoma.

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Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer

Cited by 131 publications

References 26 publications

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Sublobar resections for small-sized stage Ia lung adenocarcinoma: a Sino-Japanese multicenter study

T1a lung carcinoma: the place of segmentectomy in the treatment array

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