Segmentectomy and Wedge Resection for Elderly Patients with Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Background: Considerable controversies exist regarding the efficacies of segmentectomy and wedge resection for elderly patients with early-stage non-small cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to solve these issues. Methods: We searched the online databases PubMed, Web of Science, EMBASE, and Cochrane Library to identify eligible studies. Elderly patients were defined as ≥65 years. Early-stage NSCLC was defined as stage I based on TNM systems. The primary endpoints were survival outcomes (overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS)) and recurrence patterns. The second endpoints were perioperative morbidities. The hazard rate (HR) and odds ratio (OR) were effect sizes. Results: Sixteen cohort studies (3140 participants) and four database studies were finally included. Segmentectomy and lobectomy showed no significant difference in OS (cohort studies HR 1.00, p = 0.98; database studies HR 1.07, p = 0.14), CSS (HR 0.91, p = 0.85), or DFS (HR 1.04, p = 0.78) in elderly patients with stage I NSCLC. In contrast, wedge resection showed inferior OS (HR 1.28, p < 0.001), CSS (HR 1.17, p = 0.001) and DFS (HR 1.44, p = 0.042) compared to lobectomy. Segmentectomy also showed comparable local recurrence risk with lobectomy (OR 0.98, p = 0.98), while wedge resection showed increased risk (OR 5.46, p < 0.001). Furthermore, sublobar resections showed a decreased risk of 30/90-day mortality, pneumonia, and leak complications compared to lobectomy. Conclusion: Segmentectomy is promising when applied to elderly patients with stage I NSCLC, while wedge resection should be limited. Randomized controlled trials are warranted to validate these findings.

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Comparison Between Wedge Resection and Lobectomy/Segmentectomy for Early-Stage Non-small Cell Lung Cancer: A Bayesian Meta-analysis and Systematic Review

Annals of Surgical Oncology ◽

10.1245/s10434-021-10857-7 ◽

2021 ◽

Author(s):

Yucong Shi ◽

Sizhi Wu ◽

Shengsuo Ma ◽

Yiwen Lyu ◽

Huachong Xu ◽

...

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Early Stage ◽

Wedge Resection ◽

Meta Analysis ◽

Small Cell ◽

Small Cell Lung

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Doublet Versus Single Cytotoxic Agent as First-Line Treatment for Elderly Patients with Advanced Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Lung ◽

10.1007/s00408-012-9399-3 ◽

2012 ◽

Vol 190 (5) ◽

pp. 477-485 ◽

Cited By ~ 23

Author(s):

Wei-Xiang Qi ◽

Li-na Tang ◽

Ai-na He ◽

Zan Shen ◽

Feng Lin ◽

...

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Elderly Patients ◽

Small Cell Lung Cancer ◽

Meta Analysis ◽

Small Cell ◽

Line Treatment ◽

Small Cell Lung ◽

First Line ◽

First Line Treatment

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Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a systematic review and meta-analysis

Journal of Thoracic Disease ◽

10.21037/jtd.2017.05.79 ◽

2017 ◽

Vol 9 (6) ◽

pp. 1615-1623 ◽

Cited By ~ 23

Author(s):

Benedetta Bedetti ◽

Luca Bertolaccini ◽

Raffaele Rocco ◽

Joachim Schmidt ◽

Piergiorgio Solli ◽

...

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Meta Analysis ◽

Small Cell ◽

Stage I ◽

Small Cell Lung

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Stereotactic body radiation therapy versus surgery for patients with early-stage non–small cell lung cancer( ≤ 5cm): A systematic review and meta-analysis

10.21203/rs.3.rs-458770/v1 ◽

2021 ◽

Author(s):

Yueling Zhou ◽

Ping Wen ◽

Yue Yu ◽

Zhenyi Yang ◽

Yixuan Luo ◽

...

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Early Stage ◽

Meta Analysis ◽

Small Cell ◽

Survival Outcomes ◽

Small Cell Lung ◽

Early Stage Nsclc

Abstract Background: Stereotactic body radiation therapy (SBRT) is considered as the preferred treatment method for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is still a debate on the efficacy of SBRT and surgery. This meta-analysis aimed to compare survival outcomes of SBRT and surgery for early-stage NSCLC (≤5cm).Methods: A systematic review and meta-analysis were performed to compare survival outcomes of surgery and SBRT. And the pooled analysis was conducted with STATA 14.0 software. Results: Thirty-nine comparative studies were included for systematic review and twenty-eight of which for quantitative analysis. Compared with SBRT, overall survival (OS) was superior after surgical resection, included lobectomy, sublobar resection, video-assisted thoracoscopic surgery, and thoracotomy, for patients with early-stage NSCLC (≤5cm). And the results of subgroup analysis remained the support of surgery except for the OS of operable matched cohorts and the one matched cohort of age ≥75. However, the HR of OS showed a reduction from patients with unspecific age, ≥65 to ≥75 years old and histopathologically confirmed NSCLC to clinical NSCLC. Although cancer-specific survival and local control was superior after surgery, the recurrence rate of tumors, locoregional control, distant control, and regional control of matched patients demonstrated no significantly different outcomes between SBRT and surgery for early-stage NSCLC.Conclusions: Results show that surgery has superior OS, CSS and local control compared to SBRT for early-stage NSCLC. There is still necessary to explore the survival difference between SBRT and surgery for patients with different characteristics by large-sample, long-term follow-up randomized clinical studies.

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Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz339 ◽

2020 ◽

Vol 57 (6) ◽

pp. 1051-1060 ◽

Cited By ~ 6

Author(s):

Thomas Winckelmans ◽

Herbert Decaluwé ◽

Paul De Leyn ◽

Dirk Van Raemdonck

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Early Stage ◽

Meta Analysis ◽

Small Cell ◽

Stage I ◽

Small Cell Lung ◽

Oncological Outcomes ◽

Stage Ia

Abstract OBJECTIVES The role of segmentectomy in early-stage non-small-cell lung cancer (NSCLC) remains a matter of debate. We performed a meta-analysis to evaluate the oncological outcomes following segmentectomy versus lobectomy for stage I, stage IA only and stage IA <2 cm only. METHODS We systematically searched the literature for articles reporting on overall survival (OS), cancer-specific survival (CSS) or recurrence-free survival (RFS). The hazard ratios (HRs) were retrieved and pooled using an inverse variance-weighted approach. RESULTS Twenty-eight studies were included in the analysis. In stage I, segmentectomy was found to be inferior to lobectomy for all 3 outcomes with HR: 1.25 (P = 0.01) for OS, 1.59 (P = 0.02) for CSS and 1.40 (P < 0.001) for RFS. In stage IA, the differences were significant for OS and CSS, though not for RFS with HR: 1.31 (P = 0.04), 1.56 (P = 0.02) and 1.22 (P = 0.11), respectively. In stage IA <2 cm, no significant differences were found between segmentectomy and lobectomy with HR: 1.13 (P = 0.37) for OS, 1.02 (P = 0.95) for CSS and 1.24 (P = 0.11) for RFS. CONCLUSIONS For stages I and IA, lobectomy showed superior results whereas for tumours <2 cm, our study did not find significant differences in oncological outcomes between both groups. These results suggest that segmentectomy might be a valuable alternative to lobectomy for NSCLC in tumours <2 cm.

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