Effect Of Cuneiform Resection On The Recurrence Free Survival Rate Of Early Non-small Cell Lung Cancer During Radical Resection Of Lung Cancer

Introduction Lung cancer is one of the leading causes of cancer-related deaths worldwide.Surgery is the main treatment modality for early-stage non-small cell lung cancer,and radical lung cancer surgery(lobectomy + mediastinal lymph node dissection)is the currently accepted standard surgical procedure.However,there are still some patients who develop recurrence or metastasis within 3 years after radical lung cancer surgery.This is a challenge to us.Therefore,this study was conducted to explore whether performing lung wedge resection first during radical lung cancer surgery could increase the survival benefit of patients after surgery.Objective:To explore the effect of wedge resection and direct radical resection of lung cancer on the recurrence-free survival rate of early non-small cell lung cancer.Methods:Retrospective analysis of patients with early-stage non-small cell lung cancer admitted to Department of Thoracic Surgery of the Second Affiliated Hospital of Nanchang University from 01/2018 to 12/2019.Patients were divided into those who underwent lung wedge resection first in radical lung cancer surgery(wedge group)and those who underwent direct radical lung cancer surgery(non-wedge group)according to the surgical approach.To minimize the influence of confounding factors,propensity score-matched screening of patients enrolled in the group was then performed to collect patient’s age,gender,length of surgery,surgical bleeding,pathological diagnosis,postoperative hospital stay,postoperative drainage tube retention time,and follow-up observation of patients’ survival time and recurrence time.The Kaplan-Meier method was used to draw recurrence-free survival(RFS)curves.Hazard ratios(HR)for endpoint RFS were assessed using univariate and multifactorial Cox regression for analysis.Results:A total of 936 patients undergoing radical lung cancer surgery were screened,and a total of 245 patients met the enrollment criteria,including 101 patients in the wedge group and 144 patients in the non-wedge group.There was no statistically significant difference between patients in the wedge and non-wedge groups in terms of perioperative indicators,such as surgical bleeding volume,postoperative hospital stay,and postoperative drainage tube retention time(P > 0.05).The 4-year RFS rates were 98% and 88% in the wedge and non-wedge groups,respectively(p=0.036).Wedge resection of the tumor prior to lobectomy was an independent correlate of RFS(HR=6.226,95% CI=1.192-32.521,p=0.031).Conclusion:Preceding pulmonary wedge resection during radical lung cancer surgery in patients with early-stage non-small cell lung cancer does not increase surgical risk and contributes positively to prolonging patients’ survival time after surgery.The intrinsic mechanism may be the reduction of CTCs in the blood,providing a clinical basis as well as a theoretical foundation for standardizing the surgical steps in patients with early-stage NSCLC.