Comparison of surgical outcomes and prognosis between wedge resection and simple Segmentectomy for GGO diameter between 2cm and 3cm in non-small cell lung cancer: A multicenter and propensity score matching analysis

- and prognosis between wedge resection.
- and simple Segmentectomy for GGO diameter between 2 cm and 3 cm in non-small cell lung cancer: a multicenter and propensity score matching analysis.
- Background: As segmentectomy had become commonly used for Non-Small Cell Lung Cancer (NSCLC) treatment, which had the advantages of radical operation, however, it remains controversial owing to procedural complexity and risk of increased complications compared with wedge resection.
- We evaluated operative and postoperative outcomes of simple segmentectomy compared to wedge resection in ground-glass opacity (GGO) diameter between 2 cm and 3 cm NSCLC..
- Methods: We retrospectively reviewed 1600 clinical GGO diameter between 2 cm and 3 cm NSCLC patients who received simple segmentectomy and wedge resection between Jan 2011 and Jan 2015.
- Overall complications in simple segmentectomy group were more than wedge resection group (21% vs 3%, p = 0.03).
- p = 0.02) was significantly longer in the simple segmentectomy group.
- There was no difference in recurrence free survival (RFS) and overall survival (OS) of 5-years between simple segmentectomy group and wedge resection group.
- Postoperative pulmonary function in simple segmentectomy group recovered more slowly than wedge resection group..
- Segmentectomy could be further subdivided into simple segmentectomy and complex segmentectomy, according to surgical procedure.
- Though simple segmentectomy do not need complex procedure, surgeons still often isolate and divide suitable segmental vein, artery, bronchus, and in some cases separate into lung parenchyma especially suffering the poor intersegmental plane.
- Few studies have explored the clinical outcomes of simple segmentectomy vs wedge resection in GGO diameter between 2 cm and 3 cm NSCLC.
- We evaluated pre-oper- ative condition, operative, postoperative outcomes, prognosis and variations of pulmonary function in those patients who underwent simple segmentectomy versus wedge resection..
- All the operations were purely simple segmentectomy or wedge resection.
- We excluded patients in whom the surgeon mixed the operation, such as lobectomy + wedge resection or segmentectomy + wedge resection..
- Patients with simple segmentectomy group were matched 1-to-1 without replacement using a Conclusion: Wedge resection may have comparable efficacy as simple segmentectomy for GGO diameter between 2 cm and 3 cm NSCLC, but lead to less complications, less surgical procedure and faster recovery of pulmonary function..
- The propensity scores were then checked to ensure they were balanced across the simple segmen- tectomy and wedge resection groups.
- In general, the choice between wedge resection and seg- mental resection is a decision made by each surgeon based on expert consensus or guidelines combined with his own judgment.
- All the patients in the wedge resection group mostly need to receive CT-guided needle localization.
- If the surgical margin was not satis- fied, additional wedge resection was required to extend the distance..
- Dif- ferences in the multifarious variables between simple seg- mentectomy and wedge resection groups were assessed by Fisher’s test or the Mann-Whitney U test, in which measurement data were used by Paired t-test and count data were used by McNemar’s test.
- Pulmonary function changes after simple segmentectomy or wedge section group were compared by repeated-measures analysis of variance and time-dependent variations in the forced vital capac- ity (FVC), forced expiratory volume in 1 s (FEV1.0), pre- dicted diffusing capacity of the lung for carbon monoxide (DLCO%) and peak expiratory flow (PEF) were evaluated..
- In our study, simple segmentectomy included resec- tion of the RS2, RS6, LS LS6, or lingual segment (Table 3).
- Median operative time was obvi- ously longer for the simple segmentectomy group ver- sus the wedge resection group (110.6 min vs 71.2 min, p = 0.002, Table 4).
- Mean number of dis- sected lymph nodes during simple segmentectomy group was more than wedge resection group (4.0 VS .
- In the postoperative outcome analysis, no deaths occurred in perioperative period after segmentectomy and wedge resection.
- The median hospital stay and median length of drainage in simple segmentectomy group was longer than wedge resection group (5.2 vs 3.1, p = 0.043.
- The average hospitalization expenses in simple segmentec- tomy group was more than wedge resection group (5020$.
- Overall complications occurred in the simple segmentectomy group were more than wedge resection group (21% vs 3%, p = 0.031, Table 4)..
- The 5-year RFS and OS in simple segmentectomy group was 93.1 and 91.9%, and in wedge resection group was 96 and 95.7% before propensity score matching (Supplementary figure).
- score matching, in our research, the 5-year recurrence free survival (RFS) and overall survival (OS) in simple segmentectomy group was 94 and 95%, and in wedge resection group was 95 and 96% (Fig.
- There was no margin relapse in the 5-years.
- There were 3 patients with mediastinal lymph node metastasis in the wedge.
- group, 4 in the simple segmentectomy group, pleu- ral metastasis in the wedge group, and brain metasta- sis in the simple segmentectomy group.
- There was no significant difference in the patterns of relapse between the two groups (p = 0.22, Table 4).
- Simple segmentectomy group.
- Wedge resection group (n = 350).
- Difference a Simple segmentectomy group.
- Wedge resection group (n = 100).
- Pulmonary function.
- Finally, we compared the pulmonary functional varia- tions in the simple segmentectomy group and wedge resection (Fig.
- However, patients in the wedge resection group showed up better recovery of pulmonary function compared with simple segmentec- tomy group (p = 0.04, p = 0.032, p respec- tively.
- In recent decades, there has been so much research focusing on short and long term prognosis and com- plications between pulmonary lobectomy, segmentec- tomy and wedge resection [5, 10].
- Okada et al.
- Sublobar resection could be subdivided into segmen- tectomy and wedge resection.
- In our study, we just choose simple segmentectomy or we call it “classical segmentectomy”..
- Actually, simple segmentectomy is more conventional Table 2 Patient and tumor characteristics of simple.
- segmentectomy and wedge resection.
- wedge resection n = 100 p value.
- Pulmonary function a .
- Table 3 Tumor locations of simple segmentectomy group and wedge resection group.
- Locations simple segmentectomy.
- However, because of the worry about lymph node and margin relapse, wedge resection was taken to perform seriously and deliber- ately.
- Some studies reported that wedge resection suf- fered more incidences of local recurrence and lower OS than segmentectomy [13, 14].
- It restricted the application of wedge resection.
- However, we explored the pre-oper- ative, operative and postoperative outcomes of patients undergoing simple segmentectomy and wedge resec- tion, including morbidity, complications, surgical margin, lymph nodes, prognosis and recovery of pulmonary func- tion between two groups.
- Compared with simple segmentectomy group, wedge resection group entirely showed less operative time (71.2 min vs 110.6 min, p = 0.002), drainage time (2.2 vs 3.4 days, p = 0.04), stay in hospital (3.1 days vs 5.2 days, p = 0.043) and hospital expense (3900$ vs 5020$, p = 0.035).
- These complications are less and OS are higher than in previ- ous reports after segmentectomy or wedge resection [15, 16].
- The wedge resection group showed remarkably pri- ority on simple segmentectomy group in our study.
- In the study of Tsutani et al., postoperative recurrence occurred in 36 of 195 patients (18.5%) undergoing wedge resection and 14 of 262 patients (5.3%) undergoing segmentectomy.
- Can- cer control was better in segmentectomy than in wedge resection [20].
- Suzuki et al.
- Sublobar resection with enough surgical margin offered sufficient local control and relapse-free Table 4 Operative and postoperative data of simple segmentectomy and wedge resection.
- Variables simple segmentectomy.
- n = 100 wedge resection.
- Actually, no patient in the two groups suffered relapse at the surgical margin, which is different from Tsutani et al’ study.
- The reason may be that the surgeon may prefer to remove a larger portion of the lung during the operation of wedge resection..
- He et al.
- reported that sublobar resection patients with ≥3 evaluated lymph nodes are associated with better overall survival and lung cancer- specific survival [25].
- Similarly, Dezube et al.
- 2 The 5-year RFS and OS in simple segmentectomy group was 94 and 95%, and in wedge resection group was 95 and 96%.
- There was no difference on the RFS and OS between simple segmentectomy group and wedge resection group.
- sampling for lung cancer resections is recommended [26].
- In our study, the median number of dissected lymph nodes during operation in simple segmentec- tomy was 4 and in the wedge resection group, there is only 1.5.
- There is a relevant issue, as second primary lung cancer is often seen in the follow- up of these patients.
- Baig et al.
- reported that anatomic resection has superior long-term survival compared with wedge resection for second primary lung cancer after prior lobectomy.
- Significant improvement in survival was observed with wedge resection for second primary lung cancer when adequate lymph node dissection was per- formed [27]..
- We could find postoperative pulmonary function in segmentectomy group recover more slowly than wedge resection group according to.
- Second, because we use a propensity score matching method, the analyzed patients of segmen- tectomy group may be biased toward the similar charac- teristics of wide-wedge resection group after matching..
- In summary, wedge resection may have comparable efficacy as simple segmentectomy for GGO diameter between 2 cm and 3 cm in NSCLC, but lead to less com- plications, less surgical procedure and faster recovery of pulmonary function.
- 3 The pulmonary function changes in simple segmentectomy group and wedge resection group.
- A-D There were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), predicted diffusing capacity of the lung of carbon monoxide percentage (%DLCO) and peak expiratory flow (PEF) preoperatively at 3, 6 and 12 months postoperatively in patients undergoing simple segmentectomy group and wedge resection group.
- The 5-year RFS and OS in sim- ple segmentectomy group was 93.1 and 91.9%, and in wedge resection group was 96 and 95.7% before propensity score matching..
- All the patients and tumor characteristics of simple segmentectomy and wedge resection before propensity score matching..
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