Department of Thoracic Surgery, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China.
Department of Anesthesiology, the Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China.
J Surg Res. 2019 Nov;243:371-379. doi: 10.1016/j.jss.2019.05.058. Epub 2019 Jul 2.
Segmentectomy and wedge resection have been recommended as appropriate surgical treatments for patients with poor pulmonary function or major comorbidities. However, for stage I non-small cell lung cancer (NSCLC), it is still undecided whether survival is better with segmentectomy or with wedge resection.
A meta-analysis was performed of studies examining survival outcomes after sublobar resection in patients with stage I NSCLC. Three electronic databases were searched to identify studies that investigated overall survival, cancer-specific survival, and disease-free survival between patients receiving segmentectomy versus wedge resection. A total of 19 relevant studies published before 31 April 2018 that satisfied the inclusion criteria were included in this meta-analysis.
The 19 studies involved a total of 14,197 patients with stage I NSCLC. Overall survival was significantly better after segmentectomy than after wedge resection (hazard ratio [HR] = 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.00001). This was also true of cancer-specific survival (HR = 0.71; 95% CI, 0.64-0.79; P < 0.00001) and disease-free survival (HR = 0.73, 95% CI, 0.54-0.98; P = 0.04). A fixed-model was applied for the analysis as there was no significant heterogeneity between the studies.
Survival after lobar resection for stage I NSCLC is significantly better with segmentectomy than with wedge resection.
对于肺功能差或合并严重合并症的患者，肺段切除术和楔形切除术已被推荐为合适的手术治疗方法。然而，对于 I 期非小细胞肺癌（NSCLC），仍不确定肺段切除术和楔形切除术的生存效果哪个更好。
对 I 期 NSCLC 患者亚肺叶切除术后生存结果的研究进行了荟萃分析。通过三个电子数据库检索了调查肺段切除术与楔形切除术患者总生存、癌症特异性生存和无病生存之间差异的研究。共纳入了 19 项符合纳入标准的截止到 2018 年 4 月 31 日之前发表的相关研究。
这 19 项研究共纳入了 14197 例 I 期 NSCLC 患者。肺段切除术的总生存明显优于楔形切除术（风险比 [HR] = 0.82；95%置信区间 [CI]，0.77-0.88；P < 0.00001）。癌症特异性生存（HR = 0.71；95% CI，0.64-0.79；P < 0.00001）和无病生存（HR = 0.73，95% CI，0.54-0.98；P = 0.04）也是如此。由于研究之间没有显著异质性，因此采用固定模型进行分析。
对于 I 期 NSCLC，肺段切除术的生存效果明显优于楔形切除术。
