Intentional segmentectomy for clinical T1 N0 non-small cell lung cancer: Survival differs by segment Journal Article


Authors: Jones, G. D.; Caso, R.; Choe, G.; Tan, K. S.; Connolly, J. G.; Dycoco, J.; Molena, D.; Park, B. J.; Huang, J.; Adusumilli, P. S.; Bott, M. J.; Downey, R. J.; Travis, W. D.; Jones, D. R.; Rocco, G.
Article Title: Intentional segmentectomy for clinical T1 N0 non-small cell lung cancer: Survival differs by segment
Abstract: Background: Outcomes after segmentectomy compare favorably with those after lobectomy in patients with stage I non-small cell lung cancer (NSCLC). Whether long-term outcomes vary by segmentectomy location is unclear. We investigated whether disease-free survival (DFS) and overall survival (OS) differ by segmentectomy location after intentional segmentectomy for clinical T1 N0 M0 NSCLC. Methods: Patients who received intentional segmentectomy for cT1 N0 M0 NSCLC from 2000 to 2018 were reviewed. Patients with prior lung cancer, forced expiratory volume in 1 second of less than 50%, or R1/R2 resection were excluded. Segmentectomy groups were left (L) basilar, L segment 6, L lingula, L trisegment; right (R): basilar (R_Bas), segment 6 (R_S6), and R upper. The 5- and 10-year DFS and OS were estimated using Kaplan-Meier and compared between groups using the log-rank test. Factors associated with DFS and OS were determined using Cox proportional hazards models. Results: In total, 416 patients met the inclusion criteria. Segmentectomy groups differed with regard to surgical approach, mediastinal lymphadenectomy, lymphovascular invasion, tumor histology, margin distance, and adjuvant therapy. Long-term outcomes were worst after R_S6 resection (5-year DFS, 57.6% [95% confidence interval {CI}, 45.7%-72.7%]; OS, 66.3% [95% CI, 54.7%-80.3%]) and best after R_Bas resection (5-year DFS, 77.1% [95% CI, 59.2%-100%]; OS, 79.5% [95% CI, 60.9%-100%]). On multivariable analysis, R_S6 resection was independently associated with DFS vs R_Bas (hazard ratio, 2.89; 95% CI, 1.18-7.08; P = .02) and OS vs R_Bas (hazard ratio, 4.35; 95% CI, 1.61-11.76; P = .004). Conclusions: Resection of R_S6 is independently associated with worse DFS and OS in patients receiving intentional segmentectomy for cT1 N0 M0 NSCLC and may warrant more extensive resection, complete lymph node dissection, and closer postoperative surveillance. © 2021 The Society of Thoracic Surgeons
Keywords: adult; cancer survival; controlled study; treatment outcome; aged; disease-free survival; middle aged; cancer surgery; survival rate; retrospective studies; major clinical study; overall survival; mortality; cancer recurrence; conference paper; cancer adjuvant therapy; disease free survival; cancer staging; follow up; follow-up studies; antineoplastic agent; cancer diagnosis; lymph node dissection; neoplasm staging; tumor volume; lung resection; thoracotomy; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; cohort analysis; surgical approach; retrospective study; time factors; lung tumor; proportional hazards model; long term care; kaplan meier method; epidemiology; new york; forced expiratory volume; lung function test; non small cell lung cancer; surgical margin; time factor; procedures; propensity score; lymph vessel metastasis; humans; human; male; female; priority journal; segmentectomy; diffusing capacity for carbon monoxide
Journal Title: Annals of Thoracic Surgery
Volume: 111
Issue: 3
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2021-03-01
Start Page: 1028
End Page: 1035
Language: English
DOI: 10.1016/j.athoracsur.2020.05.166
PUBMED: 32739257
PROVIDER: scopus
PMCID: PMC8170548
DOI/URL:
Notes: Conference Paper -- Export Date: 1 April 2021 -- Source: Scopus
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MSK Authors
  1. James Huang
    161 Huang
  2. William D Travis
    675 Travis
  3. Bernard J Park
    201 Park
  4. Matthew Bott
    82 Bott
  5. Robert J Downey
    232 Downey
  6. Joseph Dycoco
    33 Dycoco
  7. David Randolph Jones
    290 Jones
  8. Daniela   Molena
    165 Molena
  9. Kay See   Tan
    166 Tan
  10. Gregory Jones
    20 Jones
  11. Raul Caso Jr
    19 Caso Jr
  12. Gaetano Rocco
    60 Rocco
  13. Giye Choe
    5 Choe