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VATS Anatomic Lung Resection for Stage I Non-Small Cell Lung Cancer (NSCLC): VATS Segmentectomy vs. VATS Lobectomy.
Matthew J Schuchert, Brian L. Pettiford, Arman Kilic, Arjun Pennathur, Raphael R. Pereira, Marco Santana, James R. Landreneau, Joshua P. Landreneau, David O. Wilson, James D. Luketich, Rodney J. Landreneau
Heart, Lung and Esophageal Surgery Institute; University of Pittsburgh Medical Center, Pittsburgh, PA
BACKGROUND:
Resection of early stage lung cancers is increasingly being performed utilizing a VATS approach. Both anatomic segmentectomy and lobectomy represent reasonable alternatives in the management of Stage I NSCLC. Little data currently exists directly comparing these VATS techniques. In the current study, we compare the perioperative and early oncologic results of VATS anatomic segmentectomy with VATS lobectomy for Stage I NSCLC.
METHODS:
A total of 109 consecutive VATS anatomic segmentectomies were performed for Stage IA (n=68) or IB (n=41) NSCLC from 2002-2008. VATS lobectomy was performed in 127 patients for Stage IA (n=70) and IB (n=57) during the same period. Primary outcome variables included hospital course, complications, mortality, recurrence patterns and survival. Statistical analysis included the t-test and Fisher’s exact test. The probability of overall and recurrence-free survival was estimated with the Kaplan-Meier method, with significance being estimated by the log rank test.
RESULTS:
Mean age was 70 years among segments and 67 among lobes (p=0.002). Gender distribution and tumor histology were similar between the VATS segmentectomy and lobectomy groups. Average tumor size was larger in the lobectomy group (2.6 cm) compared with segment group (2.1cm; p=0.008). Mean follow-up was 13.6 months for segments and 17.8 months for lobes. VATS segmentectomy was associated with decreased operative time when compared to VATS lobectomy [Table]. There was 1 (0.9%) conversion in the VATS segmentectomy group, compared with 7 in the VATS lobectomy group (5.5%; p=0.22). There were no significant differences in length of stay, perioperative morbidity, mortality or recurrence rates when comparing VATS segmentectomy to VATS lobectomy. Locoregional recurrence rates (4.6% vs. 3.9%) were similar between VATS segmentectomy and VATS lobectomy groups, respectively (p=1.00). There were no significant differences in recurrence free or overall survival.
CONCLUSIONS:
VATS segmentectomy and lobectomy can be performed safely with acceptable perioperative course, morbidity, mortality and recurrence rates. VATS segmentectomy can be performed with early outcomes similar to VATS lobectomy. The potential benefits of VATS segmentectomy compared with VATS lobectomy will need to be further evaluated by prospective, randomized trials (CALGB 140503).
VATS Segmentectomy vs. VATS Lobectomy | VATS Segmentectomy
(n=109) | VATS Lobectomy
(n=127) | Significance
(p Value) | | Operative Time (min) | 125 | 219 | 0.001 | | Estimated Blood Loss (ml) | 100 | 150 | 0.08 | | Length of Stay (days) | 5 | 6 | 0.18 | | Morbidity (%) | 20.2 | 15.7 | 0.40 | | Mortality (%) | 0 | 0 | 1.00 | | Recurrence (%) | 15.6 | 15.0 | 1.00 | | Survival (%) | 87.9 | 90.6 | 0.67 |
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