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Thorascopic Segmentectomy Promising for Stage I Lung Cancer

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Thorascopic Segmentectomy Found Promising for Stage I Lung Cancer

Elsevier Global Medical News. 2008 Jun 24, D Brunk

SAN DIEGO (EGMN) - Thorascopic segmentectomy for stage I non-small cell lung cancer can be performed safely, with acceptable morbidity and mortality, results from a single-center study showed.

In a trial of 225 consecutive cases of thorascopic segmentectomy (video-assisted thoracic surgery, or VATS), the surgeries were associated with similar recurrence rates, compared with open segmentectomy, with no apparent impact on overall survival, Dr. Matthew J. Schuchert reported at the annual meeting of the American Association for Thoracic Surgery. However, the VATS technique was associated with decreased hospital length of stay and fewer pulmonary complications, compared with the open approach.

"The use of segmentectomy for primary lung cancer fell out of favor in the mid 1990s with the publication of a lung cancer study documenting a threefold increase in recurrence rate for sublobar resection, specifically, a 2.4-fold increase after segmental resection," said Dr. Schuchert, of the Heart, Lung, and Esophageal Surgery Institute at the University of Pittsburgh Medical Center. "This clearly established lobectomy as the gold standard for treatment of early-stage lung cancer. However, with the advent of CT screening protocols and the identification of earlier and smaller lung cancers, there has been a resurgence of interest in evaluating the use of limited sublobar resection - specifically anatomic segmentectomy."

Between 2002 and 2008 Dr. Schuchert and his associates compared the outcomes of 104 stage I lung cancer patients who underwent VATS with 121 patients who underwent anatomic segmentectomy. Primary outcome variables included hospital course, complications, mortality, recurrence patterns, and survival.

The mean age of patients was 70 years, their average tumor size was 2.3 cm, and the mean follow-up was 22 months. There were no significant differences between the two groups in terms of gender, operative time or estimated blood loss.

On average, patients in the VATS group had fewer lymph nodes harvested, compared with those in the open group (6 vs. 9, respectively), a shorter hospital length of stay (5 vs. 7 days), and a significantly decreased rate of overall pulmonary complications (26% vs. 34%). Specifically, patients in the open group had significantly higher rate of pneumonia, need for bronchoscopy, respiratory failure requiring prolonged intubation or reintubation, empyema, as well as need for infusion/drainage, compared with their counterparts in the VATS group.

There were no deaths in the VATS group, compared with two in the open group, which represented an overall mortality rate of 0.9%.

Dr. Schuchert reported that overall mortality was similar between the VATS and the open group, as were the rates of overall complications (26% vs. 24%, respectively), recurrence (16% vs. 24%), and overall survival (76% vs. 76% at 2 years).

Margin-to-tumor ratios less than 1 were associated with an increased rate of recurrence, which "underscores the need for obtaining adequate margins during these resections," he said.

He emphasized that lobectomy should still be considered as primary therapy for early-stage non-small cell lung cancer, especially when adequate margins are not obtainable. "Prospective studies will be necessary to better define the potential benefits and drawbacks of anatomic segmentectomy in the treatment of stage I non-small cell lung cancer," Dr. Schuchert said. "In lesions that are small and that are confined to a specific bronchopulmonary segment, we would consider performing anatomic segmentectomy in an effort to preserve function, especially in elderly patients or in patients where lobectomy may be considered a higher risk option. We generally prefer anatomic segmentectomy over a simple wedge resection because of concern regarding an increased local recurrence rate associated with wedges, compared with segments."

He had no conflicts to disclose.

Source: http://www.oncologystat.com/home/news/T ... er_US.html


Submitted by Carole

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