Abstract
Background: Video-assisted thoracoscopic surgery (VATS) for clinical stage I non-small cell lung
cancer (NSCLC) has been widely used as a less invasive surgical procedure, but the
resection method is still controversial. We retrospectively compared the surgical
outcomes of lobectomy, segmentectomy and wedge resection. Patients and Methods: A total of 411 patients with clinical stage I NSCLC who underwent VATS (218 males
and 193 females, aged 69.3 years; 345 adenocarcinomas, 57 squamous cell carcinomas,
and 9 others) were investigated. The surgical procedure was lobectomy in 289, segmentectomy
in 38, and wedge resection in 84. Surgical outcomes were compared among these 3 groups.
Results: Demographic characteristics showed that the rate of elderly and male patients was
higher in the wedge resection group. The 5-year survival rates for the lobectomy,
segmentectomy, and wedge resection groups were 82.1, 87.2, and 55.4 %, respectively.
In the wedge resection group, the 5-year survival rate was 83.3 % in patients undergoing
intentional low-risk operations for small tumors with ground glass opacity, and 41.1 %
in those undergoing conservative high-risk operations because of comorbidities. Using
Cox's proportional multivariate analysis and sex differences, histology, and tumor
size as co-influential factors, the surgical procedure was found to be a significantly
poor prognostic factor, and the hazard ratio of wedge resection relative to lobectomy
was 4.30. Conclusion: The outcomes of VATS lobectomy and segmentectomy procedures for clinical stage I
NSCLC were equivalent, while the outcome for VATS wedge resection was inferior. VATS
wedge resection for clinical stage I NSCLC should be carefully indicated and requires
adequate patient selection.
Key words
thoracic surgery - cardiovascular surgery - coronary bypass surgery
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Dr. Hiroshige Nakamura
Department of General Thoracic Surgery
Tottori University Hospital
Nishicho 36-1
683-8504 Yonago
Japan
Phone: +81 8 59 38 67 37
Fax: +81 8 59 38 67 30
Email: hnaka@med.tottori-u.ac.jp