Abstract:
Objective To compare the outcomes between sublobar resection and lobectomy for T1 non-small cell lung cancer(NSCLC)(tumor diameter ≤3 cm).
Methods The clinical data of 278 patients with T1 NSCLC undergoing surgery in Department of Thoracic Surgery in China-Japan Friendship Hospital between January 2007 and December 2014 were collected. The mean age of these patients was (60.7±10.4) years. Sixty-one patients received sublobar resection(wedge resection, n=35; segmentectomy, n=26), and the other 217 underwent lobectomy. There was 81.7% of adenocarcinoma, 12.9% of squamous cell carcinoma, and 5.4% of cancer of other types. High differentiated, moderate differentiated and poor differentiated cancer accounted for 8.6%, 27.0% and 20.5%, respectively, and there were 43.9% cases with undermined differentiation status. In cases of adenocarcinoma, there were 4.0% preinvasive lesions, 7.5% minimally-invasive lesions and 88.5% invasive adenocarcinoma. There were 86.7% cases with T1N0M0, 1.1% cases with T1N1M0 and 12.2% cases with T1N2M0.
Results Compared with lobectomy group, patients were much elder, the duration of operation was much shorter, and the percentage of lesion≤2 cm was significantly larger in sublobar resection group(t=0.496, P=0.009; t=8.082, P=0.029; χ2=2.105, P=0.002). There was no significant difference in forced expiratory volume in one second(FEV1), FEV1%, surgical procedure and incidence of postoperative complications between two groups(t=0.065, P=0.713; t=2.12, P=0.085; χ2=0.399, P=0.274; χ2=0.438, P=0.490). For NSCLC patients with T1N0M0, the 5-year survival of sublobar resection group and lobectomy group were 73.9% and 83.5%, respectively, with no significant difference(P=0.883). In sublobar resection group, the 5-year survival of patients undergoing wedge resection and segmentectomy were 79.4% and 70.6%, respectively, with no significant difference(P=0.979). Multivariate analysis indicated that only age and mediastinal lymph node metastasis N2 were risk factors for poor prognosis(HR=1.07, P=0.048; HR=5.56, P=0.011). There was no significant difference in 5-year survival between sublobar resection group and lobectomy group(HR=1.38, P=0.552).
Conclusions For NSCLC patients with T1N0M0, though sublobar resection can not totally substitute lobectomy, it may become a main surgical procedure for senior patients with poor pulmonary reserve.
Key words:
Non-small cell lung cancer,
Sublobar resection,
Lobectomy,
Early stage
Qianli Ma, Deruo Liu, Yongqing Guo, Bin Shi, Yanchu Tian, Zhiyi Song, Chaoyang Liang. Comparison of outcomes between sublobar resection and lobectomy for T1 non-small cell lung cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(01): 29-34.