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Segmentectomy for Inner Location Small-Sized Non-Small Cell Lung Cancer: Is It Feasible?
Shinya Tane1, Kenji Kimura2, Nahoko Shimizu2
1Department of General Thoracic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka City, Japan.
Background:
The efficacy of segmentectomy for inner small-sized non-small-cell lung cancer (NSCLC) remains unknown. We aimed to elucidate whether segmentectomy for inner small-sized NSCLC, defined using a novel 3-dimensional measuring method, yields feasible oncologic outcomes compared with segmentectomy for outer lesions.
Methods:
We retrospectively analyzed patients with small-sized (<2 cm) cN0 NSCLC who underwent segmentectomy between January 2007 and December 2020. The tumor centrality ratio, which was measured by using 3-dimensional reconstruction software, was evaluated. The location of tumor origin was confirmed pathologically. Cases with a ratio <2:3 and >2:3 were allocated to the inner group and outer group, respectively. Oncologic outcomes were compared between the 2 groups.
Results:
Our cohort was divided into the inner group (n = 75) and outer group (n = 127). The proximal distance from a tumor was >20 mm in all cases. The tumor centrality ratio was associated with the pathologic origin of a tumor. The rate of unforeseen positive lymph node metastasis was significantly higher in the inner group (P = .04). There were no significant differences in the 5-year recurrence-free survival (91% vs 87%, P = .67). Univariate analysis identified age, consolidation/tumor ratio, the presence of ground-glass opacity, and lymphovascular invasion, but not tumor centrality, as significant prognostic factors for recurrence-free survival. In the multivariate analysis, the presence of ground-glass opacity and lymphovascular invasion remained significant.
Conclusions:
Regarding oncologic outcomes, segmentectomy with a safety proximal distance could be feasible, even for inner small-sized NSCLC. Tumor invasiveness, not tumor centrality, may influence tumor recurrence.
Insights
Segmentectomy is a feasible surgical option for inner small-sized non-small-cell lung cancer (NSCLC), even with higher lymph node metastasis rates. Tumor invasiveness, not location, appears to be the key factor influencing recurrence in NSCLC patients.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonology
Background:
- Efficacy of segmentectomy for inner small-sized non-small-cell lung cancer (NSCLC) is not well-established.
- Novel 3D measurement method used to define inner vs. outer tumor locations.
Purpose of the Study:
- To compare oncologic outcomes of segmentectomy for inner versus outer small-sized NSCLC.
- To determine feasibility of segmentectomy for inner small-sized NSCLC.
Main Methods:
- Retrospective analysis of 202 patients with <2 cm cN0 NSCLC undergoing segmentectomy (2007-2020).
- Tumor centrality ratio assessed using 3D reconstruction; inner (<2:3) vs. outer (>2:3) groups defined.
- Comparison of oncologic outcomes between inner and outer groups.
Main Results:
- Higher rate of unforeseen positive lymph node metastasis in the inner group (P=.04).
- No significant difference in 5-year recurrence-free survival between groups (91% vs 87%, P=.67).
- Ground-glass opacity and lymphovascular invasion were significant prognostic factors for recurrence.
Conclusions:
- Segmentectomy is feasible for inner small-sized NSCLC with adequate safety margins.
- Tumor invasiveness, rather than centrality, may be a more critical factor for NSCLC recurrence.
