Department of Thoracic Surgery, West China Hospital.
Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, People's Republic of China.
Int J Surg. 2024 Jul 1;110(7):4231-4239. doi: 10.1097/JS9.0000000000001361.
Whether wedge resection is oncological suitable for ground glass opacity (GGO)-dominant non-small cell lung cancer (NSCLC) ≤2 cm is still debatable. The aim of this study is to investigate the short-term and long-term outcomes of intentional wedge resection and segmentectomy for those patients.
This was a real-world study from one of the largest thoracic surgery centers in West China. Patients who underwent intentional wedge resection or segmentectomy for ≤2 cm CTR (consolidation-to-tumor) ≤0.5 NSCLC were consecutively included between December 2009 and December 2018. Data were prospectively collected and retrospectively reviewed. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), and lung cancer-specific survival (LCSS), were analyzed using Cox proportional model.
A total of 1209 patients were included (497 in the wedge resection group, 712 in the segmentectomy group). Compared to segmentectomy, wedge resection had a significantly lower rate of complications (3.8 vs. 7.7%, P =0.008), a shorter operating time (65 min vs. 114 min, P <0.001), and a shorter postoperative stay (3 days vs. 4 days, P <0.001). The median follow-up was 70.1 months. The multivariate Cox model indicated that wedge resection had survival outcomes that were similar to segmentectomy in terms of 5-year OS (98.8 vs. 99.6%, HR=1.98, 95% CI: 0.59-6.68, P =0.270), 5-year RFS (98.8 vs. 99.5%, HR=1.88, 95% CI: 0.56-6.31, P =0.307) and 5-year LCSS (99.9 vs. 99.6%, HR=1.76, 95% CI: 0.24-13.15, P =0.581).
Intentional wedge resection is an appropriate choice for ≤2 cm GGO-dominant NSCLC.
楔形切除术是否适用于 2cm 以下以磨玻璃密度影（GGO）为主的非小细胞肺癌（NSCLC）仍存在争议。本研究旨在探讨针对这些患者行意向性楔形切除术和节段切除术的短期和长期疗效。
这是一项来自华西地区最大胸外科中心之一的真实世界研究。2009 年 12 月至 2018 年 12 月期间，连续纳入了接受以 GGO 为主、肿瘤直径≤2cm、CTR（肿瘤实质比）≤0.5cm 的 NSCLC 患者行意向性楔形切除术或节段切除术的患者。前瞻性收集数据并进行回顾性分析。采用逆概率治疗加权法（IPTW）来平衡基线特征。采用 Cox 比例风险模型分析总生存（OS）、无复发生存（RFS）和肺癌特异性生存（LCSS）等长期预后。
共纳入 1209 例患者（楔形切除术组 497 例，节段切除术组 712 例）。与节段切除术相比，楔形切除术的并发症发生率明显较低（3.8% vs. 7.7%，P=0.008），手术时间更短（65min vs. 114min，P<0.001），术后住院时间更短（3d vs. 4d，P<0.001）。中位随访时间为 70.1 个月。多因素 Cox 模型表明，楔形切除术的 5 年 OS（98.8% vs. 99.6%，HR=1.98，95%CI：0.59-6.68，P=0.270）、5 年 RFS（98.8% vs. 99.5%，HR=1.88，95%CI：0.56-6.31，P=0.307）和 5 年 LCSS（99.9% vs. 99.6%，HR=1.76，95%CI：0.24-13.15，P=0.581）与节段切除术相似。
对于 2cm 以下以磨玻璃密度影为主的 NSCLC，楔形切除术是一种合适的选择。
