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Ann Cardiothorac Surg. 2014 Mar;3(2):153-9. doi: 10.3978/j.issn.2225-319X.2014.02.10.

Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma.

Author information

1
1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan.

Abstract

BACKGROUND:

Despite the increasing prevalence of the early discovery of small-sized non-small cell lung cancers (NSCLCs), particularly adenocarcinoma, sublobar resection has not yet gained acceptance for patients who can tolerate lobectomy.

METHODS:

We compared the outcomes of segmentectomy (n=155) and lobectomy (n=479) in 634 consecutive patients with clinical stage IA lung adenocarcinoma and in propensity score-matched pairs. Those who had undergone wedge resection were excluded.

RESULTS:

The 30-day postoperative mortality rate in this population was zero. Patients with large or right-sided tumors, high maximum standardized uptake value (SUVmax), pathologically invasive tumors (with lymphatic, vascular, or pleural invasion), and lymph node metastasis underwent lobectomy significantly more often. Three-year recurrence-free survival (RFS) was significantly higher after segmentectomy compared to lobectomy (92.7% vs. 86.9%, P=0.0394), whereas three-year overall survival (OS) did not significantly differ (95.7% vs. 94.1%, P=0.162). Multivariate analyses of RFS and OS revealed age and SUVmax as significant independent prognostic factors, whereas gender, tumor size and procedure (segmentectomy vs. lobectomy) were not. In 100 propensity score-matched pairs with variables adjusted for age, gender, tumor size, SUVmax, tumor location, the three-year RFS (90.2% vs. 91.5%) and OS (94.8% vs. 93.3%) after segmentectomy and lobectomy respectively were comparable.

CONCLUSIONS:

Segmentectomy with reference to SUVmax should be considered as an alternative for clinical stage IA adenocarcinoma, even for low-risk patients.

KEYWORDS:

Adenocarcinoma; lobectomy; lung cancer; segmentectomy; sublobar resection

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