From Japan: Comparison of lung cancer surgical procedures and outcomes

http://www.ncbi.nlm.nih.gov/pubmed/21480132

Thorac Cardiovasc Surg. 2011 Apr;59(3):137-141. Epub 2011 Apr 8.
Comparison of the Surgical Outcomes of Thoracoscopic Lobectomy, Segmentectomy, and Wedge Resection for Clinical Stage I Non-Small Cell Lung Cancer.
Nakamura H, Taniguchi Y, Miwa K, Adachi Y, Fujioka S, Haruki T, Takagi Y, Yurugi Y.

Department of General Thoracic Surgery, Tottori University Hospital, Yonago, Japan.
Abstract
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) for clinical stage I non-small cell lung cancer (NSCLC) has been widely used as a less invasive surgical procedure, but the resection method is still controversial. We retrospectively compared the surgical outcomes of lobectomy, segmentectomy and wedge resection.

PATIENTS AND METHODS: A total of 411 patients with clinical stage I NSCLC who underwent VATS (218 males and 193 females, aged 69.3 years; 345 adenocarcinomas, 57 squamous cell carcinomas, and 9 others) were investigated. The surgical procedure was lobectomy in 289, segmentectomy in 38, and wedge resection in 84. Surgical outcomes were compared among these 3 groups.

RESULTS: Demographic characteristics showed that the rate of elderly and male patients was higher in the wedge resection group. The 5-year survival rates for the lobectomy, segmentectomy, and wedge resection groups were 82.1, 87.2, and 55.4 %, respectively. In the wedge resection group, the 5-year survival rate was 83.3 % in patients undergoing intentional low-risk operations for small tumors with ground glass opacity, and 41.1 % in those undergoing conservative high-risk operations because of comorbidities. Using Cox's proportional multivariate analysis and sex differences, histology, and tumor size as co-influential factors, the surgical procedure was found to be a significantly poor prognostic factor, and the hazard ratio of wedge resection relative to lobectomy was 4.30.

CONCLUSION: The outcomes of VATS lobectomy and segmentectomy procedures for clinical stage I NSCLC were equivalent, while the outcome for VATS wedge resection was inferior. VATS wedge resection for clinical stage I NSCLC should be carefully indicated and requires adequate patient selection.