Oncological Outcomes of Sub-Lobar Resection Versus Lobectomy for Stage I Non-Small Cell Lung Cancer
Although lobectomy has been the treatment of choice for early-stage non-small cell lung cancer (NSCLC), sub-lobar resection (i.e., segmentectomy or wedge resection) has emerged as an alternative over time due to its ability to preserve additional lung function. This meta-analysis explores the surviv...
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Veröffentlicht in: | The Journal of surgical research 2024-10, Vol.302, p.302-316 |
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Zusammenfassung: | Although lobectomy has been the treatment of choice for early-stage non-small cell lung cancer (NSCLC), sub-lobar resection (i.e., segmentectomy or wedge resection) has emerged as an alternative over time due to its ability to preserve additional lung function. This meta-analysis explores the survival outcomes of sub-lobar resection versus lobectomy in patients with stage I NSCLC (tumor size: ≤2 cm).
We conducted a systematic search of PubMed, EMBASE, and the Cochrane Library from inception up to July 28, 2023. The hazard ratios and odds ratios for overall survival (OS), disease-free survival (DFS), and mortality were calculated using the random effects model.
A total of 27 studies, comprising 10,449 patients, were included. Sub-lobar resection demonstrated comparable OS and DFS to that of lobectomy. Similarly, there was no significant risk of mortality associated with any of the groups. However, the subgroup analysis according to patient selection (intentional, compromised, not specified, and both [intentional and compromised]) showed that the patients in the compromised subgroup had a poor DFS with sub-lobar resection as compared to lobectomy (hazard ratio: 1.52, confidence interval: 1.14-2.02, P = 0.004). Additionally, there was no significant difference in OS, DFS, or overall mortality in the results stratified by surgical procedure or patient selection.
The patients with stage I NSCLC who underwent sub-lobar resection showed a significantly worse DFS and OS in the “compromised group.” However, there was no overall significant difference in OS, DFS, or mortality in the sub-lobar resection group as compared to lobectomy.
•An analysis comprising 10,449 patients showed no significant difference in overall survival (OS) and disease-free survival (DFS) between sub-lobar resection and lobectomy for stage I non-small cell lung cancer with tumor size ≤2 cm.•Subgroup analysis revealed that patients with compromised health had a poorer DFS and OS with sub-lobar resection compared to lobectomy. |
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ISSN: | 0022-4804 1095-8673 1095-8673 |
DOI: | 10.1016/j.jss.2024.07.049 |