Lobectomy versus segmentectomy: a propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. (25th October 2021)

• Record Type: Journal Article
• Authors: Nomori, Hiroaki; Yamazaki, Ikuo; Machida, Youichi; Otsuki, Ayumu; Cong, Yue; Sugimura, Hiroshi; Oyama, Yu
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 34:Number 1(2022)
• Page Start: 57
• Page End: 65
• Publication Date: 2021-10-25
• Subjects: Lung cancer -- Segmentectomy -- Lobectomy -- Prognosis -- Pulmonary function; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab212
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: To demonstrate the differences in clinical outcomes between lobectomy and segmentectomy for non-small cell lung cancer using propensity score matching. METHODS: A single-centre, retrospective, matched cohort study was conducted in clinical T1N0M0 non-small cell lung cancer patients treated by surgery between 2012 and 2019. Differences in freedom from recurrence, overall survival, postoperative complications, chest drainage and preservation of pulmonary function between lobectomy and segmentectomy were evaluated using the propensity score model. Matched variables of patients were age, sex, comorbidity index and pulmonary function. Matched variables of tumours were tumour size, T-stage, fluorodeoxyglucose uptake on positron emission tomography, histopathology, lobe site and tumour distance ratio from the hilum. RESULTS: Of the 112 patients treated by lobectomy and 233 patients treated by segmentectomy, 93 patients each from both groups were selected after the matching. The median tumour distance ratio from hilum was 0.7 in lobectomy and 0.8 in segmentectomy group ( P = 0.59), i.e. almost outer third tumour location. There were no significant differences in freedom from recurrence ( P = 0.38), overall survival ( P = 0.51), postoperative complications ( P = 0.94), drainage period ( P = 0.53) and prolonged air leakage ( P = 0.82) between the two. Median preservation of pulmonary function was 93.2% after segmentectomy, which was significantly higher than 85.9% after lobectomy ( P < 0.001). CONCLUSIONS: Freedom from recurrence, overall survival, postoperative complications and chest drainage were similar between segmentectomy and lobectomy. Segmentectomy could be one of the options for clinical T1N0M0 non-small cell lung cancer located outer third as well as being able to preserve pulmonary function better than lobectomy. Clinical trial registration: Name: Retrospective analysis of segmentectomy and lobectomy for cT1N0M0 non-small cell lung cancer Date of approval: February 2014 Number of IRB approval: 14-003. Abstract : Pulmonary segmentectomy is expected to change the surgical treatment of clinical (c) T1N0M0 non-small cell lung cancer (NSCLC).