Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Outcomes and Survival for Early-Stage Non-Small Cell Lung Cancer Following Wedge Resection or Lobectomy: A Propensity Score-Matched Analysis Using a Novel Peruvian Registry

  • Wildor Samir Cubas Llalle (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Franco Alban-Sanchez (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Jose Torres-Neyra (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Wildor Dongo-Minaya (Yawar Research Club of Cardiovascular Surgery, Cayetano Heredia Peruvian University) ;
  • Katherine Inga-Moya (Yawar Research Club of Cardiovascular Surgery, Cayetano Heredia Peruvian University) ;
  • Johnny Mayta (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Juan Velasquez (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Jorge Mantilla (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Karen Mendoza (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Rafael Vicuna (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital) ;
  • Victor Mendizabal (Department of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital)
  • Received : 2024.03.26
  • Accepted : 2024.06.27
  • Published : 2024.11.05
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Abstract

Background: Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables. Methods: This observational, analytical, longitudinal study used propensity score-matched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I-II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000-2020. After PSM, 650 cases were analyzed (resection, n=325; lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoergional-recurrence-free survival (LRFS). Results: The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011). Conclusion: Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.

Keywords

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

  1. Gomez Hernandez MT, Valentin NN, Rodriguez Alvarado I, Fuentes Gago M, Varela Simo G, Jimenez Lopez MF. Changes in the risk of mortality and morbidity after lung resection in the last 20 years. Arch Bronconeumol (Engl Ed) 2020;56:23-7. https://doi.org/10.1016/j.arbres.2019.04.010
  2. Bernard A, Cottenet J, Pages PB, Quantin C. Diffusion of minimally invasive approach for lung cancer surgery in France: a nationwide, population-based retrospective cohort study. Cancers (Basel) 2023;15:3283. https://doi.org/10.3390/cancers15133283
  3. Stamenovic D, Messerschmidt A, Schneider T. Surgery for lung tumors in the elderly: a retrospective cohort study on the influence of advanced age (over 80 years) on the development of complications by using a multivariate risk model. Int J Surg 2018;52:141-8. https://doi.org/10.1016/j.ijsu.2018.02.008
  4. Li SJ, Zhao L, Wang HY, et al. Gustave Roussy Immune Score based on a three-category risk assessment scale serves as a novel and effective prognostic indicator for surgically resectable early-stage non-small-cell lung cancer: a propensity score matching retrospective cohort study. Int J Surg 2020;84:25-40. https://doi.org/10.1016/j.ijsu.2020.10.015
  5. Sakane T, Nakajima K, Iwata H, et al. Lobectomy versus proton therapy for stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 2023;166:1490-501. https://doi.org/10.1016/j.jtcvs.2023.08.030
  6. Liu J, Yang X, Liu X, Xu Y, Huang H. Predictors of readmission after pulmonary resection in patients with lung cancer: a systematic review and meta-analysis. Technol Cancer Res Treat 2022;21:15330338221144512. https://doi.org/10.1177/15330338221144512
  7. Behinaein P, Treffalls J, Hutchings H, Okereke IC. The role of sublobar resection for the surgical treatment of non-small cell lung cancer. Curr Oncol 2023;30:7019-30. https://doi.org/10.3390/curron-col30070509
  8. Manzano C, Fuentes-Martin A, Zuil M, Gil Barturen M, Gonzalez J, Cilleruelo-Ramos A. Questions and answers in lung cancer. Open Respir Arch 2023;5:100264. https://doi.org/10.1016/j.opresp.2023.100264
  9. Deboever N, Mitchell KG, Feldman HA, Cascone T, Sepesi B. Current surgical indications for non-small-cell lung cancer. Cancers (Basel) 2022;14:1263. https://doi.org/10.3390/cancers14051263
  10. Kamel MK, Lee B, Harrison SW, Port JL, Altorki NK, Stiles BM. Sublobar resection is comparable to lobectomy for screen-detected lung cancer. J Thorac Cardiovasc Surg 2022;163:1907-15. https://doi.org/10.1016/j.jtcvs.2021.06.056
  11. Raman V, Yang CJ, Deng JZ, D'Amico TA. Surgical treatment for early stage non-small cell lung cancer. J Thorac Dis 2018;10(Suppl 7):S898-904. https://doi.org/10.21037/jtd.2018.01.172
  12. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage IA non-small-cell lung cancer. N Engl J Med 2023;388:489-98. https://doi.org/10.1056/nejmoa2212083
  13. Na KJ, Kim YT. Optimal resection strategies for small-size lung cancer: is a wedge enough?: is lobectomy too much? JTCVS Open 2023;16:17-21. https://doi.org/10.1016/j.xjon.2023.10.012
  14. Shi Y, Wu S, Ma S, et al. Comparison between wedge resection and lobectomy/segmentectomy for early-stage non-small cell lung cancer: a Bayesian meta-analysis and systematic review. Ann Surg Oncol 2022;29:1868-79. https://doi.org/10.1245/s10434-021-10857-7
  15. Song C, Lu Z, Li D, Pan S, Li N, Geng Q. Survival after wedge resection versus lobectomy for stage IA second primary NSCLC with previous lung cancer-directed surgery. Front Oncol 2022;12:890033. https://doi.org/10.3389/fonc.2022.890033
  16. Ding H, Song N, Zhang P, Jiang G, Wang H. Wedge resection plus adequate lymph nodes resection is comparable to lobectomy for small-sized non-small cell lung cancer. Front Oncol 2022;12:1022904. https://doi.org/10.3389/fonc.2022.1022904
  17. Bertolaccini L, Cara A, Chiari M, et al. Real-world survival outcomes of wedge resection versus lobectomy for cT1a/b cN0 cM0 non-small cell lung cancer: a single center retrospective analysis. Front Oncol 2023;13:1226429. https://doi.org/10.3389/fonc.2023.1226429
  18. Lv F, Wang B, Xue Q, Gao S. Lobectomy vs. sublobectomy for stage I non-small-cell lung cancer: a meta-analysis. Ann Transl Med 2021;9:751. https://doi.org/10.21037/atm-20-460
  19. Divisi D, De Vico A, Zaccagna G, Crisci R. Lobectomy versus sublobar resection in patients with non-small cell lung cancer: a systematic review. J Thorac Dis 2020;12:3357-62. https://doi.org/10.21037/jtd.2020.02.54
  20. Moon RJ, Taylor R, Miklavc P, Mehdi SB, Grant SW, Bittar MN. Wedge resection versus lobectomy in T1 lung cancer patients: a propensity matched analysis. J Cardiothorac Surg 2023;18:252. https://doi.org/10.1186/s13019-023-02303-4
  21. Zhang X, Lin G, Li J. Comparative effectiveness of lobectomy, segmentectomy, and wedge resection for pathological stage I non-small cell lung cancer in elderly patients: a population-based study. Front Surg 2021;8:652770. https://doi.org/10.3389/fsurg.2021.652770
  22. Fan X, Liang Y, Bai Y, Yang C, Xu S. Conditional survival rate estimates of lobectomy, segmentectomy and wedge resection for stage IA1 non-small cell lung cancer: a population-based study. Oncol Lett 2020;20:1607-18. https://doi.org/10.3892/ol.2020.11713
  23. Salazar MC, Canavan ME, Walters SL, et al. The survival advantage of lobectomy over wedge resection lessens as health-related life expectancy decreases. JTO Clin Res Rep 2021;2:100143. https://doi.org/10.1016/j.jtocrr.2021.100143
  24. Song W, Hou Y, Zhang J, Zhou Q. Comparison of outcomes following lobectomy, segmentectomy, and wedge resection based on pathological subtyping in patients with pN0 invasive lung adenocarcinoma ≤1 cm. Cancer Med 2022;11:4784-95. https://doi.org/10.1002/cam4.4807
  25. Kamigaichi A, Mimae T, Tsubokawa N, et al. Wedge resection is an acceptable treatment option for radiologically low-grade lung cancer with solid predominance. Interdiscip Cardiovasc Thorac Surg 2023;36:ivac285. https://doi.org/10.1093/icvts/ivac285
  26. Lin H, Peng Z, Zhou K, et al. Differential efficacy of segmentectomy and wedge resection in sublobar resection compared to lobectomy for solid-dominant stage IA lung cancer: a systematic review and meta-analysis. Int J Surg 2024;110:1159-71. https://doi.org/10.1097/js9.0000000000000896
  27. Guo J, Liu Y, Tian X, et al. Less is more in solid-dominant lung cancer?: sublobar resection versus lobectomy for solid-dominant stage IA non-small-cell lung cancer: a meta-analysis study. Mol Clin Oncol 2019;11:465-73. https://doi.org/10.3892/mco.2019.1914
  28. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 2022;399:1607-17. https://doi.org/10.1016/s0140-6736(21)02333-3
  29. Altorki NK, McGraw TE, Borczuk AC, et al. Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early-stage non-small-cell lung cancer: a single-centre, randomised phase 2 trial. Lancet Oncol 2021;22:824-35. https://doi.org/10.1016/s1470-2045(21)00149-2