Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Eur J Surg Oncol. 2019 May;45(5):845-850. doi: 10.1016/j.ejso.2018.10.534. Epub 2018 Nov 1.
Segmentectomy has emerged as a lung parenchymal sparring alternative to the gold standard lobectomy in non-small cell lung cancer (NSCLC) patients. We hypothesized that there is parity between functional, local recurrence and survival outcomes.
Parenchymal sparring procedures including anatomical segmentectomies were propensity score matched 1:1 with lobectomies (n = 64). The primary outcomes included survival, functional and oncological outcomes. The oncological outcomes were: post-operative histology, clear margins and local recurrence rates. Kaplan Meier survival curves were used to compare the survival. Oncological and functional variables were assessed by Fischer exact test and t-test.
The pre-operative performance status, ASA grade, lung function, risk factors, surgical approach and tumour histology were similar between the groups. The tumour size was significantly higher for lobectomies (32.4 ± 17 vs. 24.6 ± 12 mm, p = 0.01). The tumour staging in the segmentectomy group was similar to the lobectomy group (Ia; 50 vs. 34%; Ib: 29 vs. 37%; IIa 11 vs. 9.3%; IIb 5 vs. 14%; IIIa 5 vs. 4.6%, p = 0.83). The loco-regional recurrence was lower in the segmentectomy group (1.5 vs. 3.1%, p = 0.69). The up-staging and down-staging post-surgery was similar in both groups, while neo-adjuvant therapy was used in 5 lobectomy and 3 segmentectomy cases. The survival was similar at 1 year between the groups (88 vs. 92%, p = 0.65). Between 4 and 5 years, the survival reduced in the parenchymal sparing group to 39% vs. 68% in the lobectomy group (p = 0.04).
Surgical selection bias could be an important confounder in the selection of patients undergoing segmentectomy. Similar up and down staging were demonstrated in the two groups. This is one of the first studies to investigate the results of segmentectomy versus lobectomy in stage II/IIIa NSCLC tumours. No significant differences were found in functional outcomes, but the survival decreased after 4 years in the segmentectomy group, which could be explained by lower survival in the stage II/IIIa tumours treated with segmentectomy.
在非小细胞肺癌（NSCLC）患者中，肺段切除术作为一种保留肺实质的手术方式，已经取代了金标准的肺叶切除术。我们假设其在功能、局部复发和生存结果方面具有等效性。
对行解剖性肺段切除术的患者进行倾向评分匹配，1:1 匹配行肺叶切除术的患者（n=64）。主要结局包括生存、功能和肿瘤学结果。肿瘤学结局包括术后组织学、切缘情况和局部复发率。采用 Kaplan-Meier 生存曲线比较生存情况。采用 Fisher 确切检验和 t 检验评估肿瘤学和功能变量。
两组患者术前的体能状态、ASA 分级、肺功能、危险因素、手术入路和肿瘤组织学相似。肺叶切除术的肿瘤直径明显大于肺段切除术（32.4±17 vs. 24.6±12 mm，p=0.01）。肺段切除术组的肿瘤分期与肺叶切除术组相似（Ia 期：50% vs. 34%；Ib 期：29% vs. 37%；IIa 期：11% vs. 9.3%；IIb 期：5% vs. 14%；IIIa 期：5% vs. 4.6%，p=0.83）。肺段切除术组局部区域复发率较低（1.5% vs. 3.1%，p=0.69）。两组术后的升期和降期情况相似，5 例肺叶切除术和 3 例肺段切除术患者接受了新辅助治疗。两组患者的 1 年生存率相似（88% vs. 92%，p=0.65）。4 至 5 年后，肺段切除术组的生存率下降至 39%，而肺叶切除术组为 68%（p=0.04）。
手术选择偏倚可能是影响患者选择行肺段切除术的一个重要混杂因素。两组的升期和降期情况相似。这是第一项研究肺段切除术与肺叶切除术治疗 II/IIIa 期非小细胞肺癌的结果的研究之一。在功能结局方面没有发现显著差异，但肺段切除术组在 4 年后的生存率下降，这可能是由于 II/IIIa 期肿瘤行肺段切除术的生存率较低所致。
