Segmentectomy Is Equivalent to Lobectomy in Hypermetabolic Clinical Stage IA Lung Adenocarcinomas. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Recent studies have suggested that lobectomy and segmentectomy hold equivalent oncologic outcomes, particularly for small, peripheral, subsolid nodules. However, for hypermetabolic nodules that are frequently associated with high rates of nodal disease, recurrence, or mortality, the optimum oncologic procedure was not assessed. We hypothesize that for hypermetabolic, cT1 N0 adenocarcinoma, lobectomy and segmentectomy are associated with comparable outcomes. METHODS: A prospectively collected database was queried for patients with clinical stage IA lung adenocarcinoma who underwent lobectomy or segmentectomy (2000 to 2016) for hypermetabolic tumors (maximum standard uptake value [SUVmax] ≥ 3g/dL). To obtain balanced groups of patients, a propensity matching analysis was done. RESULTS: A total of 414 patients had hypermetabolic tumors and underwent lobectomy or segmentectomy. Patients were propensity matched (4:1) (lobectomy: n = 156, segmentectomy: n = 46). Patients in the lobectomy group had a higher rate of pathologic nodal upstaging (17% versus 7%, p = 0.085) and a higher pathologic upstaging rate (38% versus 26%, p = 0.143) than the segmentectomy group. In addition, the lobectomy group had a higher number of resected lymph nodes than the segmentectomy group (median lymph nodes resected: 14 versus 7, p < 0.001). No differences were found in in 5-year recurrence-free survival (RFS; 72% versus 69%, p = 0.679) or in 5-year cancer-specific survival (CSS; 92% versus 83%, p = 0.557) between patients who underwent lobectomy or segmentectomy, respectively. CONCLUSIONS: Our data show that lobectomy and segmentectomy are comparable oncologic procedures for patients with carefully staged cT1 N0 lung adenocarcinoma with hypermetabolic tumors (SUVmax ≥ 3g/dL). Although lobectomy was associated with a more thorough lymph node dissection, this did not translate into a higher rate of RFS or CSS compared with segmentectomy.

publication date

  • September 19, 2018

Research

keywords

  • Adenocarcinoma of Lung
  • Neoplasm Staging
  • Pneumonectomy

Identity

Scopus Document Identifier

  • 85057067880

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2018.07.042

PubMed ID

  • 30240764

Additional Document Info

volume

  • 107

issue

  • 1