de-Torres Juan P, Girón-Flamenco Juan José, Rodríguez María, de la Fuente-Añó Alejandra, Perna Valerio, Mesa-Guzmán Miguel, Murillo Diego, Alcaide Ana Belén, Campo Arancha, Zulueta Javier J, Bastarrika Gorka, Ezponda Ana, Ocón María Del Mar, Felgueroso Carmen, Pueyo Jesús, Lozano Dolores, Montuenga Luis M, Berto Juan, Perez-Warnisher Teresa, Di-Frisco I Madeleine, Seijo Luis M
Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain.
PLoS One. 2025 May 8;20(5):e0320704. doi: 10.1371/journal.pone.0320704. eCollection 2025.
Little information is available on the surgical treatment options for patients with Airway Obstruction (AO) and early-stage non-small cell lung cancer (NSCLC) followed in lung cancer screening programs (LCS). This study aims to compare the potential impact of anatomical sub lobar resections vs. lobectomies in these patients.
This is a retrospective analysis of participants who underwent surgical resections within a Lung Cancer Screening Program, including those with AO (post bronchodilator FEV1/FVC < 0.70). The short-term survival, locoregional recurrence, perioperative complications, and difference between pre and postoperative pulmonary function tests were compared between the surgical groups in those with AO.
Anatomical sub lobar resections or lobectomies for Stages IA and IB NSCLC were performed in 133 patients. Out of these, 57 had AO. Anatomical sub lobar resections were non-inferior to lobectomies for short-term survival in patients with AO (3-year survival rate: 95.8% vs. 97%, p = 0.83). In these patients, sub lobar resections had a higher recurrence rate (12.5% vs 0%, p < 0.01). No significant differences were found in postoperative complications between surgical techniques (sub lobar 33% vs lobectomy 24%, p = 0.44). Lastly, no significant difference was found on the change between pre and postoperative FEV1 and DLCO (p = 0.96 and 0.79 for FEV1 and DLCO, respectively).
The present retrospective analysis suggests that sub lobar resection might be the best surgical option for treating early-stage NSCLC in patients with AO, where lung function preservation techniques are desired, but requires closer follow up to detect recurrence. Further studies in larger samples should confirm our findings.
关于肺癌筛查项目（LCS）中气道阻塞（AO）和早期非小细胞肺癌（NSCLC）患者的手术治疗选择，目前可用信息较少。本研究旨在比较解剖性亚肺叶切除术与肺叶切除术对这些患者的潜在影响。
这是一项对在肺癌筛查项目中接受手术切除的参与者的回顾性分析，包括患有AO（支气管扩张剂后FEV1/FVC < 0.70）的患者。比较了AO患者手术组之间的短期生存率、局部区域复发率、围手术期并发症以及术前和术后肺功能测试的差异。
133例患者接受了IA期和IB期NSCLC的解剖性亚肺叶切除术或肺叶切除术。其中，57例患有AO。对于AO患者，解剖性亚肺叶切除术在短期生存方面不劣于肺叶切除术（3年生存率：95.8%对97%，p = 0.83）。在这些患者中，亚肺叶切除术的复发率更高（12.5%对0%，p < 0.01）。手术技术之间在术后并发症方面未发现显著差异（亚肺叶切除术33%对肺叶切除术24%，p = 0.44）。最后，术前和术后FEV1和DLCO的变化未发现显著差异（FEV1和DLCO的p值分别为0.96和0.79）。
本回顾性分析表明，对于希望保留肺功能技术的AO患者，亚肺叶切除术可能是治疗早期NSCLC的最佳手术选择，但需要更密切的随访以检测复发。更大样本的进一步研究应证实我们的发现。
