| Background: In china,lung cancer ranks first in both the incidence and cancerrelated mortality rate of men and the incidence is second to breast cancer but the cancerrelated mortality rate is the first in women.For early-stage non-small cell lung cancer(NSCLC),the current golden standard of treatment is still lobectomy plus systematic lymph node dissection.The changes in the spectrum of lung cancer in recent years have deepened the understanding of thoracic surgeons on early-stage lung cancer dominated by ground glass opacity(GGO).This led to further exploration of surgical methods and resection extent,presenting the popularity of the minimally invasive surgery and segmental/wedge resection.Anatomically,the upper lobe of the left lung can be divided into two parts: the Tri-segment and the Lingual segment,each of which has its own independent bronchial and arteriovenous structures,which correspond to the right upper lobe and the right middle lobe respectively.Previous studies have suggested that the oncological outcomes of left upper lobe and left upper lobe proper segmentectomy may be equivalent to some extent,but the effect of both on tumors with different imaging manifestations and new pathological subtypes is still unknown.This study aims to investigate the oncological outcomes of video-assisted thoracoscopic(VATS)left upper tri-segmentectomy(LTS)versus left upper lobectomy(LUL)for patients presenting with stage I NSCLC.Methods: A retrospective analysis identified 1543 consecutive patients presenting to Shanghai Pulmonary Hospital with NSCLC for VATS-LTS or LUL from 2013-2017.First,we studied the characterization of the patients before matching.Then We performed propensity score matching with the ratio of 1:1 for age,sex,radiological findings,pathological type,tumor size,and stage,yielding 273 pairs of patients with similar baselines.The radiological findings of patients in this study were divided into four groups based on preoperative high-resolution computed tomography: pure GGO,GGO predominant,solid predominant,and pure solid.Finally,disease-free survival(DFS)and overall survival(OS)were estimated by the Kaplan-Meier method and compared using the Log-rank test.The outcome of the two surgical methods in different radiological findings and pathological subtypes was further analyzed.Results: The median follow-up time was 51.5 months.Before matching,the patients who underwent LUL presented with a more advanced stage and larger tumor size(p < 0.001 for both)compared with LTS.In addition,a higher proportion of NSCLC consisted of solid-dominant and solid tumors(p < 0.001).In contrast,adenocarcinoma comprised a higher proportion of the pathology for patients undergoing LTS(p=0.006).After propensity score matching,there were no significant differences between the two cohorts in terms of gender,age,smoking status,radiological findings,pathological type,tumor size and stage(p=0.86,p=0.42,p=0.55,p=0.84,p=0.88,p=0.45 and p=0.86 respectively).There were no significant differences in operative duration(2.11±0.64 versus 2.49±5.96 h,p=0.30),total blood loss(106.19±170.83 versus 97.07±149.34 m L,p=0.51)and operation complications(10% versus8%,p=0.37)between LUL and LTS.Patients undergoing LUL had longer postoperative hospital stay(5.55±3.00 versus 4.87±2.33 days,p=0.003),greater tumor margin distance(3.3±1.2 versus 3.1±0.9 cm,p<.001)and greater number of lymph nodes harvested(8.0±3.2 versus 6.8±3.3,p<.001)than LTS,but the margin/tumor ratio was not statistically different(2.5±1.6 versus 2.3±1.1,p=0.11).Median DFS(49.5versus 54.3 months,p=0.77)and OS(49.5 versus 55.0 months,p=0.88)were not significantly different between patients undergoing LTS and LUL,and similar outcomes were noted across subgroups of patients stratified by tumor stages,pathological type,and radiographic manifestations.Conclusions: VATS-LTS and LUL had comparable oncological outcomes for stage I NSCLC,regardless of tumor pathological types and radiological findings,as long as negative margins were confirmed.Background: In recent years,segmentectomy has been recognized as an alternative to lobectomy for early-stage peripheral non-small lung cancer.However,the long-term functional advantages of segmentectomy remain controversial.We have investigated the short-term and long-term outcomes between video-assisted thoracoscopic(VATS)left upper tri-segmentectomy(LTS)and left upper lobectomy(LUL)in stage I nonsmall cell lung cancer(NSCLC)and concluded that there were no significant differences in postoperative complications and disease-free survival.The purpose of this study was to analyze the difference in pulmonary function changes between LTS and LUL for NSCLC.Methods: The patients with stage I NSCLC who underwent VATS-LTS(44 cases)or LUL(81 cases)for the intention of cure in our hospital from October 2019 to October 2020 were retrospectively analyzed.The baseline characteristics and pulmonary function differences before and after surgery were analyzed between the two groups.Paired boxplots were used to show the changes in forced vital capacity(FVC)and forced expiratory volume in 1 second(FEV1)with predicted values,and the Wilcoxon test was used to compare the differences.The percentage of post-and preoperative FVC,FEV1,and percentage of FEV1/the predicted value(FEV1%)was used as recovery rate to evaluate the changes of pulmonary function.The violin diagram was used to display and t test to compare whether there was a difference in the recovery rate of the two surgical methods.Results: There were no significant differences in baseline characteristics(including gender,age,weight,height,body mass index,and smoking history)between the two groups.In terms of preoperative pulmonary function,there were no significant differences in FVC,the percentage of FVC/predicted value(FVC%),FEV1,FEV1%,and FEV1/FVC between the two groups.In terms of postoperative lung function,there were no significant differences in FVC,predicted FVC,FEV1,predicted FEV1 and FEV1/FVC between the two groups(p=0.46,p=0.45,p=0.89,p=0.54 and p=0.15).For postoperative FVC and FEV1,LUL and LTS were significantly lower than predicted value(p < 0.001),but both postoperative FVC% and FEV1% were not significant difference(90.61±14.44 versus 89.57±10.72,p=0.68;86.52±16.29 versus 87.20±12.16,p=0.81).Compared with preoperative pulmonary function,there were also no significant differences between LUL and LTS in terms of FEV1 recovery rate,FEV1% recovery rate and FVC recovery rate(86.69±8.91 and 89.20±9,respectively).8.44,p=0.12;89.64±9.16 vs.91.87±8.22,p=0.70;89.65±12.67 vs.90.41±9.30,p=0.18).Conclusion: For patients with stage I NSCLC,normal preoperative pulmonary function,no extensive thoracic adhesions,and no postoperative pleural effusion,atelectasis or pneumothorax,the changes in pulmonary function were similar for VATSLTS and LUL. |
PDF Full Text Request