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Surgery Today

, Volume 46, Issue 12, pp 1370–1382 | Cite as

Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients?

  • Alfonso Fiorelli
  • Francesco Paolo Caronia
  • Niccolò Daddi
  • Domenico Loizzi
  • Luca Ampollini
  • Nicoletta Ardò
  • Luigi Ventura
  • Paolo Carbognani
  • Rossella Potenza
  • Francesco Ardissone
  • Francesco Sollitto
  • Sandro Mattioli
  • Francesco Puma
  • Mario Santini
  • Mark Ragusa
Original Article

Abstract

Purposes

The aim of this study was to evaluate whether sublobar resection could achieve recurrence and survival rates equivalent to lobectomy in high-risk elderly patients.

Methods

We conducted a retrospective multicenter study that including all consecutive patients (aged >75 years) who underwent operation for clinical stage I non-small cell lung cancer (NSCLC). The clinicopathological data, postoperative morbidity and mortality, recurrence rate and vital status were retrieved. The overall survival, cancer-specific survival and disease-free survival were also assessed.

Results

Two hundred and thirty-nine patients (median age 78 years) were enrolled. Lobectomies were performed in 149 (62.3 %) patients and sublobar resections in 90 (39 segmentectomies, 51 wedge resections). There were no differences in the recurrence rates following lobar versus sublobar resections (19 versus 23 %, respectively; p = 0.5) or the overall survival (p = 0.1), cancer-specific survival (p = 0.3) or disease-free survival (p = 0.1). After adjusting for 1:1 propensity score matching and a matched pair analysis, the results remained unchanged. A tumor size >2 cm and pN2 disease were independent negative prognostic factors in unmatched (p = 0.01 and p = 0.0003, respectively) and matched (p = 0.02 and p = 0.005, respectively) analyses.

Conclusions

High-risk elderly patients may benefit from sublobar resection, which provides an equivalent long-term survival compared to lobectomy.

Keywords

Sublobar resection Lobectomy Surgery Elderly Non-small cell lung cancer 

Notes

Acknowledgments

The authors declare that they have no conflicts of interest and received no funding for the present paper.

References

  1. 1.
    Aberle DR, Abtin F, Brown K. Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. J Clin Oncol. 2013;31(8):1002–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Liu Y, Huang C, Liu H, Chen Y, Li S. Sublobectomy versus lobectomy for stage IA (T1a) non-small-cell lung cancer: a meta-analysis study. World J Surg Oncol. 2014;12:138.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fan J, Wang L, Jiang GN, Gao W. Sublobectomy versus lobectomy for stage I non-small-cell lung cancer, a meta-analysis of published studies. Ann Surg Oncol. 2012;19:661–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Zhang Y, Sun Y, Wang R, Ye T, Zhang Y, Chen H. Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer. J Surg Oncol. 2015;111:334–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Cao C, Chandrakumar D, Gupta S, Yan TD, Tian DH. Could less be more?—a systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection. Lung Cancer. 2015.Google Scholar
  6. 6.
    Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Whitson BA, Groth SS, Andrade RS, Maddaus MA, Habermann EB, D’Cunha J. Survival after lobectomy versus segmentectomy for stage I non-small cell lung cancer: a population-based analysis. Ann Thorac Surg. 2011;92:1943–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Wang S, Wong ML, Hamilton N, Davoren JB, Jahan TM, Walter LC. Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans. J Clin Oncol. 2012;30:1447–55.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Fiorelli A, Vicidomini G, Mazzella A, Messina G, Milione R, Di Crescenzo VG, et al. The influence of body mass index and weight loss on outcome of elderly patients undergoing lung cancer resection. Thorac Cardiovasc Surg. 2014;62:578–87.CrossRefPubMedGoogle Scholar
  10. 10.
    Okami J, Ito Y, Higashiyama M, Nakayama T, Tokunaga T, Maeda J, et al. Sublobar resection provides an equivalent survival after lobectomy in elderly patients with early lung cancer. Ann Thorac Surg. 2010;90:1651–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Mery CM, Pappas AN, Bueno R, Colson YL, Linden P, Sugarbaker DJ, et al. Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest. 2005;128:237–45.CrossRefPubMedGoogle Scholar
  12. 12.
    Dell’Amore A, Monteverde M, Martucci N, Sanna S, Caroli G, Dolci G, et al. Lobar and sub-lobar lung resection in octogenarians with early stage non-small cell lung cancer: factors affecting surgical outcomes and long-term results. Gen Thorac Cardiovasc Surg. 2015;63:222–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Okami J, Higashiyama M, Asamura H, Goya T, Koshiishi Y, Sohara Y, for the Japanese Joint Committee of Lung Cancer Registry, et al. Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer. J Thorac Oncol. 2009;4:1247–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Landreneau RJ, Normolle DP, Christie NA, Awais O, Wizorek JJ, Abbas G, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol. 2014;32:2449–55.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Sienel W, Dango S, Kirschbaum A, Cucuruz B, Hörth W, Stremmel C, et al. Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg. 2008;33:728–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Wolf AS, Richards WG, Jaklitsch MT, Gill R, Chirieac LR, Colson YL, et al. Lobectomy versus sublobar resection for small (2 cm or less) non-small cell lung cancers. Ann Thorac Surg. 2011;92:1819–23.CrossRefPubMedGoogle Scholar
  17. 17.
    El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg. 2006;82:408–15.CrossRefPubMedGoogle Scholar
  18. 18.
    Altorki NK, Yip R, Hanaoka T, Bauer T, Aye R, Kohman L, I-ELCAP Investigators, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg. 2014;147:754–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Kent M, Landreneau R, Mandrekar S, Hillman S, Nichols F, Jones D, et al. Segmentectomy versus wedge resection for non-small cell lung cancer in high-risk operable patients. Ann Thorac Surg. 2013;96:1747–54.CrossRefPubMedGoogle Scholar
  20. 20.
    Fang W, Xiang Y, Zhong C, Chen Q. The IASLC/ATS/ERS classification of lung adenocarcinoma—a surgical point of view. J Thorac Dis. 2014;6:S552–60.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132(4):769–75.CrossRefPubMedGoogle Scholar
  22. 22.
    Nakamura H, Takagi M. Clinical impact of the new IASLC/ATS/ERS lung adenocarcinoma classification for chest surgeons. Surg Today. 2015;45(11):1341–51.CrossRefPubMedGoogle Scholar
  23. 23.
    Takenaka T, Inamasu E, Yoshida T, Toyokawa G, Nosaki K, Hirai F, Yamaguchi M, Seto T, Takenoyama M, Ichinose Y. Post-recurrence survival of elderly patients 75 years of age or older with surgically resected non-small cell lung cancer. Surg Today. 2015. PubMed PMID: 26070907 (epub ahead of print).Google Scholar
  24. 24.
    Nakayama H, Yamada K, Saito H, Oshita F, Ito H, Kameda Y, Noda K. Sublobar resection for patients with peripheral small adenocarcinomas of the lung: surgical outcome is associated with features on computed tomographic imaging. Ann Thorac Surg. 2007;84(5):1675–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Dominguez-Ventura A, Allen MS, Cassivi SD, Nichols FC, Deshamps C, Pairolero PC. Lung cancer in octogenarians: factors affecting morbidity and mortality after pulmonary resection. Ann Thorac Surg. 2006;82:1175–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Port JL, Kent MS, Korst RJ, Libby D, Pasmantier M, Altorki NK. Tumor size predicts survival within stage IA non-small cell lung cancer. Chest. 2003;124(5):1828–33.CrossRefPubMedGoogle Scholar
  27. 27.
    Okada M, Sakamoto T, Nishio W, Uchino K, Tsubota N. Characteristics and prognosis of patients after resection of non-small cell lung carcinoma measuring 2 cm or less in greatest dimension. Cancer. 2003;98:535–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2016

Authors and Affiliations

  • Alfonso Fiorelli
    • 1
  • Francesco Paolo Caronia
    • 2
  • Niccolò Daddi
    • 3
  • Domenico Loizzi
    • 4
  • Luca Ampollini
    • 5
  • Nicoletta Ardò
    • 4
  • Luigi Ventura
    • 5
  • Paolo Carbognani
    • 5
  • Rossella Potenza
    • 6
  • Francesco Ardissone
    • 7
  • Francesco Sollitto
    • 4
  • Sandro Mattioli
    • 3
  • Francesco Puma
    • 6
  • Mario Santini
    • 1
  • Mark Ragusa
    • 8
  1. 1.Thoracic Surgery UnitSecond University of NaplesNaplesItaly
  2. 2.Thoracic Surgery UnitIstituto Oncologico del MediterraneoCataniaItaly
  3. 3.Thoracic Surgery UnitUniversity of BolognaBolognaItaly
  4. 4.Thoracic Surgery UnitUniversity of FoggiaFoggiaItaly
  5. 5.Thoracic Surgery UnitUniversity of ParmaParmaItaly
  6. 6.Thoracic Surgery UnitUniversity of PerugiaPerugiaItaly
  7. 7.Thoracic Surgery UnitSan Luigi Hospital, University of TurinTurinItaly
  8. 8.Thoracic Surgery UnitUniversity of TerniTerniItaly

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