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The Journal of Thoracic and... Jan 2022The optimal mode of surgery for ground-glass opacity dominant peripheral lung cancer defined with thoracic thin-section computed tomography remains unknown.
BACKGROUND
The optimal mode of surgery for ground-glass opacity dominant peripheral lung cancer defined with thoracic thin-section computed tomography remains unknown.
METHODS
We conducted a single-arm confirmatory trial to evaluate the efficacy and safety of sublobar resection for ground-glass opacity dominant peripheral lung cancer. Lung cancer with maximum tumor diameter 2.0 cm or less and with consolidation tumor ratio 0.25 or less based on thin-section computed tomography were registered. The primary end point was 5-year relapse-free survival. The planned sample size was 330 with the expected 5-year relapse-free survival of 98%, threshold of 95%, 1-sided α of 5%, and power of 90%. The trial is registered with University Hospital Medical Information Network Clinical Trials Registry, number University Hospital Medical Information Network 000002008.
RESULTS
Between May 2009 and April 2011, 333 patients were enrolled from 51 institutions. Median age was 62 years (interquartile range, 56-68), and 109 were smokers. Median maximum tumor diameter was 1.20 cm (1.00-1.54). Median maximum tumor diameter of consolidation was 0 (0.00-0.20). The primary end point, 5-year relapse-free survival, was estimated on 314 patients who underwent sublobar resection. Operative modes were 258 wide wedge resections and 56 segmentectomies. Median pathological surgical margin was 15 mm (0-55). The 5-year relapse-free survival was 99.7% (90% confidence interval, 98.3-99.9), which met the primary end point. There was no local relapse. Grade 3 or higher postoperative complications based on Common Terminology Criteria for Adverse Effect v3.0 were observed in 17 patients (5.4%), without any grade 4 or 5.
CONCLUSIONS
Sublobar resection with enough surgical margin offered sufficient local control and relapse-free survival for lung cancer clinically resectable N0 staged by computed tomography with 3 or fewer peripheral lesions 2.0 cm or less amenable to sublobar resection and with a consolidation tumor ratio of 0.25 or less.
Topics: Female; Humans; Japan; Lung; Lung Neoplasms; Male; Margins of Excision; Middle Aged; Multidetector Computed Tomography; Neoplasm Staging; Pneumonectomy; Postoperative Complications; Prognosis; Progression-Free Survival; Treatment Outcome; Tumor Burden
PubMed: 33487427
DOI: 10.1016/j.jtcvs.2020.09.146 -
The Lancet. Respiratory Medicine Dec 2018Increased detection of small-sized, peripheral, non-small-cell lung cancer has renewed interest in sublobar resection instead of lobectomy, the traditional standard of... (Comparative Study)
Comparative Study Randomized Controlled Trial
Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503).
BACKGROUND
Increased detection of small-sized, peripheral, non-small-cell lung cancer has renewed interest in sublobar resection instead of lobectomy, the traditional standard of care for early-stage lung cancer. We aimed to assess morbidity and mortality associated with lobar and sublobar resection for early-stage lung cancer.
METHODS
CALGB/Alliance 140503 is a multicentre, international, non-inferiority, phase 3 trial in patients with peripheral non-small-cell lung cancer clinically staged as T1aN0. Patients were recruited from 69 academic and community-based institutions in Australia, Canada, and the USA. Patients were randomly assigned intraoperatively to either lobar or sublobar resection. The random assignment was based on permuted block randomisation without concealment and was stratified according to radiographic tumour size, histology, and smoking status. The primary endpoint of the trial is disease-free survival; here, we report a post-hoc, exploratory, comparative analysis of perioperative mortality and morbidity associated with lobar and sublobar resection. Perioperative mortality was defined as death from any cause within 30 days and 90 days of surgical intervention and was calculated for all randomised patients. Morbidity was graded using Common Terminology Criteria for Adverse Events version 4.0. All analyses were done on an intention-to-treat basis for randomised patients with data available. This trial is registered with ClinicalTrials.gov, number NCT00499330.
FINDINGS
Between June 15, 2007, and March 13, 2017, 697 patients were randomly allocated to either lobar resection (n=357) or sublobar resection (n=340; 59% wedge resection). Six (0·9%) patients died by 30 days, four (1·1%) after lobar resection and two (0·6%) after sublobar resection; by 90 days, ten (1·4%) patients had died, six (1·7%) after lobar resection and four (1·2%) after sublobar resection (difference at 30 days, 0·5%, 95% CI -1·1 to 2·3; difference at 90 days, 0·5%, 95% CI -1·5 to 2·6). An adverse event of any grade occurred in 193 (54%) of 355 patients after lobar resection and 172 (51%) of 337 patients after sublobar resection. Adverse events of grade 3 or worse occurred in 54 (15%) patients assigned lobar resection and in 48 (14%) patients assigned sublobar resection. No differences between surgical approaches were noted in cardiac or pulmonary complications. Grade 3 haemorrhage (requiring transfusion) occurred in six (2%) patients assigned lobar resection and eight (2%) patients assigned sublobar resection. Prolonged air leak occurred in nine (3%) patients after lobar resection and two (1%) patients after sublobar resection.
INTERPRETATION
Our post-hoc analysis showed that perioperative mortality and morbidity did not seem to differ between lobar and sublobar resection in physically and functionally fit patients with clinical T1aN0 non-small-cell lung cancer. These data may affect the daily choices made by patients and their doctors in establishing the best treatment approach for stage I lung cancer.
FUNDING
National Cancer Institute.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Female; Humans; Logistic Models; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Postoperative Complications
PubMed: 30442588
DOI: 10.1016/S2213-2600(18)30411-9 -
The Journal of Thoracic and... Sep 2014
Topics: Clinical Competence; Female; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Lung Neoplasms; Male; Pneumonectomy; Quality Indicators, Health Care
PubMed: 24685382
DOI: 10.1016/j.jtcvs.2014.02.042 -
The Journal of Thoracic and... Jan 2015
Topics: Female; Humans; Lung Neoplasms; Male; Pneumonectomy; Postoperative Complications
PubMed: 25524676
DOI: 10.1016/j.jtcvs.2014.09.075 -
Medical Principles and Practice :... 2022Pulmonary artery stump thrombosis (PAST) following pneumonectomies/lobectomies is rare; its clinical importance is unknown. The objectives of this study were to analyze...
OBJECTIVES
Pulmonary artery stump thrombosis (PAST) following pneumonectomies/lobectomies is rare; its clinical importance is unknown. The objectives of this study were to analyze the prevalence and risk factors of PAST and the clinical significance in patients with pneumonectomy/lobectomy.
METHODS
All adult cases who underwent pneumonectomy/lobectomy in our hospital for any reason and who underwent control contrast-enhanced thoracic CT during the follow-up period were included in the study. Demographic and clinical features of the patients, data on surgery, and the features of thrombi were recorded.
RESULTS
During the 4-year study period, a total of 454 patients underwent pneumonectomy/lobectomy (93 pneumonectomy and 361 lobectomy). Among the patients, 202 patients (50 pneumonectomy and 152 lobectomy) with at least one follow-up thorax CT were included in the analyses. PAST was detected in 9 (4.5%) of 202 patients and mostly seen in patients with pneumonectomy (lobectomy: 2.6% vs. pneumonectomy: 10%, p = 0.043) and in patients whose pulmonary artery was ligated by using stapler (suture ligation 1% vs. stapler: 7.4%, p = 0.034). Pulmonary artery stump was also longer in patients with PAST (8.48 ± 11.22 mm vs. 23.55 ± 11.22 mm, p < 0.001). Univariate logistic regression analysis showed that pneumonectomy and longer pulmonary artery stump length were found to be significantly associated with PAST (p = 0.041 and p = 0.001, respectively).
CONCLUSIONS
PAST was detected in 4.5% of our subjects undergoing lobectomy/pneumonectomy. PAST was found to be significantly higher in subjects who underwent pneumonectomy, those with longer pulmonary artery stump, and those with pulmonary artery stump ligated by using stapler.
Topics: Adult; Humans; Hypertension, Pulmonary; Lung Neoplasms; Pneumonectomy; Postoperative Complications; Pulmonary Veins; Retrospective Studies; Thrombosis; Venous Thrombosis
PubMed: 35051926
DOI: 10.1159/000522095 -
The Journal of Thoracic and... Nov 2014
Topics: Female; Humans; Lung Neoplasms; Male; Pneumonectomy; Postoperative Complications
PubMed: 25172324
DOI: 10.1016/j.jtcvs.2014.07.080 -
Pneumologie (Stuttgart, Germany) Jan 2016
Topics: Collapse Therapy; Germany; History, 20th Century; Humans; Pneumonectomy; Pulmonary Atelectasis; Thoracotomy; Tuberculosis, Pulmonary
PubMed: 26789433
DOI: 10.1055/s-0041-108309 -
Diagnostic and Interventional Imaging Oct 2016The major lung resections are the pneumonectomies and lobectomies. The sublobar resections are segmentectomies and wedge resections. These are performed either through... (Review)
Review
The major lung resections are the pneumonectomies and lobectomies. The sublobar resections are segmentectomies and wedge resections. These are performed either through open surgery through a thoracotomy or by video-assisted mini-invasive surgery for lobectomies and sublobar resections. Understanding the procedures involved allows the normal postoperative appearances to be interpreted and these normal anatomical changes to be distinguished from potential postoperative complications. Surgery results in a more or less extensive physiological adaptation of the chest cavity depending on the lung volume, which has been resected. This adaptation evolves during the initial months postoperatively. Chest radiography and computed tomography can show narrowing of the intercostal spaces, a rise of the diaphragm and shift of the mediastinum on the side concerned following major resections.
Topics: Adenocarcinoma; Adult; Aged; Female; Follow-Up Studies; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Solitary Pulmonary Nodule; Surgery, Computer-Assisted; Surgical Instruments; Thoracic Surgery, Video-Assisted; Thoracostomy; Thoracotomy; Tomography, X-Ray Computed
PubMed: 27687830
DOI: 10.1016/j.diii.2016.08.014 -
The Journal of Thoracic and... Jan 2015
Topics: Female; Humans; Lung Neoplasms; Male; Pneumonectomy; Postoperative Complications
PubMed: 25524677
DOI: 10.1016/j.jtcvs.2014.10.098 -
Journal of Cardiothoracic Surgery Apr 2023Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following... (Review)
Review
OBJECTIVES
Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjective symptomatic relief, objective radiological imaging, and treatment durability.
METHODS
A systematic review was performed up to and including February 2022 based on the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. All studies that presented the management of symptomatic patients > 16 years of age with radiologically confirmed PPS were included. The primary outcome was the identification of the optimal treatment strategy and the secondary outcome was durability of the treatment. The Oxford Centre for Evidence Based Medicine level was assigned to each study.
RESULTS
A total of 330 papers were identified and reviewed; 41 studies met the inclusion criteria. Data including patient demographics, indication for initial pneumonectomy, presenting symptoms, management approach, outcomes, and follow-up were assessed and analysed. Management approaches were divided into three categories: (a) mediastinal repositioning using implant prostheses; (b) endobronchial stenting; (c) other corrective procedures. One hundred and four patients were identified in total and of those, 87 underwent mediastinal repositioning with insertion of a prosthetic implant. Complications included over- or under-filling of the prosthesis (8.5%) and implant leakage (8.9%).
CONCLUSION
Management of PPS using a prosthetic implant to reposition the mediastinum is the treatment of choice. Key adjuncts to optimise surgical approach and minimise complications include pre-operative CT volumetric analysis to guide implant size and intra-operative transoesophageal echocardiography to guide mediastinal repositioning.
Topics: Humans; Pneumonectomy; Mediastinum; Thorax; Prostheses and Implants; Prosthesis Implantation; Syndrome
PubMed: 37038182
DOI: 10.1186/s13019-023-02278-2