M. A. IJsseldijk1,2, M. Shoni3, C. Siegert5, J. Seegers2, T. Van Engelenburg2,5, T. Tsai3, A. Lebenthal3,4,5, R. Ten Broek1,2 1Radboud University Medical Center,General Surgery,Nijmegen, GELDERLAND, Netherlands 2Slingeland Hospital,Surgery,Doetinchem, GELDERLAND, Netherlands 3Brigham And Women’s Hospital,Surgery,Boston, MA, USA 4Harvard School Of Medicine,Brookline, MA, USA 5VA Boston Healthcare System,West Roxbury, MA, USA
Introduction:
The optimal treatment of small (T1a) non-small cell lung cancer (NSCLC) remains subject to debate. Lobar resection is considered the standard of care. However, recent studies indicate sublobar resection (segmentectomy or wedge resection) as a promising, parenchymal sparing treatment yielding comparable oncological outcomes. We conducted a systematic review and meta-analysis to compare oncological outcomes after lobar resections and parenchymal sparing resections in T1a NSCLC.
Methods:
We searched MEDLINE, PubMed, EMBASE, Web of Knowledge and CENTRAL to identify studies reporting overall survival (OS) or disease-free survival (DFS) following lobar resection or parenchymal sparing resections in early-stage NSCLC. Two researchers independently identified studies and extracted data. Oncological outcomes after lobar resection and parenchymal sparing resections were compared using the Mantel-Haenszel method and outcomes were pooled for each surgical modality using the inverse variance method.
Results:
A total of 8781 studies were identified, from which 24 articles were included. There was no difference in 5-year OS in pT1a tumors when lobar resection was compared to a lung parenchymal sparing resection (Relative Risk=0.90 (95%CI 0.80-1.02)). Moreover, there was no difference in 5-year DFS for pT1a tumors or 5-year OS for cT1a tumors between lobar surgery and a lung parenchymal sparing resection. Strikingly, there was a minor difference in 5-year DFS favoring a parenchymal sparing resection over lobar surgery for cT1a tumors.
The point estimates of 5-year OS of both comparative and non-comparative studies for pT1a tumors were 86% (95% CI: 84-89%) following lobar resection (n=1538), 83% (95%CI: 75- 91%) following segmentectomy (n = 402) and 71% (95% CI: 65 – 76%) following wedge resection (n = 65). There were no differences in pooled estimates for 5-year OS in cT1a tumors and 5-year DFS for pT1a tumors.
Conclusion:
This systematic review and meta-analysis shows that parenchymal sparing surgery in the form of segmentectomy yields equivocal results in terms of 5-year OS or DFS compared to lobar surgery for T1a NSCLC tumors. However, nodal upstaging is present in approximately 10% of patients.
