Comparison of pulmonary segmentectomy and lobectomy

Safety results of a randomized trial

West Japan Oncology Group, Japan Clinical Oncology Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: No definitive comparisons of surgical morbidity between segmentectomy and lobectomy for non–small cell lung cancer have been reported. Methods: We conducted a randomized controlled trial to confirm the noninferiority of segmentectomy to lobectomy in regard to prognosis (trial No. JCOG0802/WJOG4607L). Patients with invasive peripheral non–small cell lung cancer tumor of a diameter ≤2 cm were randomized to undergo either lobectomy or segmentectomy. The primary end point was overall survival. Here, we have focused on morbidity and mortality. Predictors of surgical morbidity were evaluated by the mode of surgery. Segmentectomy was categorized into simple and complex. Simple segmentectomy was defined as segmental resection of the right or left segment 6, left superior, or lingular segment. Complex segmentectomy was resection of the other segment. This trial is registered with the University Hospital Medical Information Network–Clinical Trial Registry (UMIN000002317). Results: Between August 10, 2009, and October 21, 2014, 1106 patients (lobectomy n = 554 and segmentectomy n = 552)were enrolled. No mortality was noted. Complications (grade ≥ 2)occurred in 26.2% and 27.4% in the lobectomy and segmentectomy arms (P =.68), respectively. Fistula/pulmonary-lung (air leak)was detected in 21 (3.8%)and 36 (6.5%)patients in the lobectomy and segmentectomy arms (P =.04), respectively. Multivariable analysis revealed that predictors of pulmonary complications, including air leak and empyema (grade ≥ 2)were complex segmentectomy (vs lobectomy)(odds ratio, 2.07; 95% confidence interval, 1.11-3.88; P =.023), and > 20 pack-years of smoking (odds ratio, 2.61; 95% confidence interval, 1.14-5.97; P =.023). Conclusions: There was no difference in almost any postoperative measure of intraoperative and postoperative complication in segmentectomy and lobectomy patients, except more air leakage was observed in the segmentectomy arm. Segmentectomy will be a standard treatment if the superior pulmonary function and noninferiority in overall survival are confirmed.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Segmental Mastectomy
Safety
Lung
Air
Morbidity
Non-Small Cell Lung Carcinoma
Odds Ratio
Confidence Intervals
Empyema
Survival
Mortality
Intraoperative Complications
Fistula
Registries
Randomized Controlled Trials

Keywords

  • complex segmentectomy
  • intentional sublobar resection
  • morbidity
  • prognosis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of pulmonary segmentectomy and lobectomy : Safety results of a randomized trial. / West Japan Oncology Group; Japan Clinical Oncology Group.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: No definitive comparisons of surgical morbidity between segmentectomy and lobectomy for non–small cell lung cancer have been reported. Methods: We conducted a randomized controlled trial to confirm the noninferiority of segmentectomy to lobectomy in regard to prognosis (trial No. JCOG0802/WJOG4607L). Patients with invasive peripheral non–small cell lung cancer tumor of a diameter ≤2 cm were randomized to undergo either lobectomy or segmentectomy. The primary end point was overall survival. Here, we have focused on morbidity and mortality. Predictors of surgical morbidity were evaluated by the mode of surgery. Segmentectomy was categorized into simple and complex. Simple segmentectomy was defined as segmental resection of the right or left segment 6, left superior, or lingular segment. Complex segmentectomy was resection of the other segment. This trial is registered with the University Hospital Medical Information Network–Clinical Trial Registry (UMIN000002317). Results: Between August 10, 2009, and October 21, 2014, 1106 patients (lobectomy n = 554 and segmentectomy n = 552)were enrolled. No mortality was noted. Complications (grade ≥ 2)occurred in 26.2{\%} and 27.4{\%} in the lobectomy and segmentectomy arms (P =.68), respectively. Fistula/pulmonary-lung (air leak)was detected in 21 (3.8{\%})and 36 (6.5{\%})patients in the lobectomy and segmentectomy arms (P =.04), respectively. Multivariable analysis revealed that predictors of pulmonary complications, including air leak and empyema (grade ≥ 2)were complex segmentectomy (vs lobectomy)(odds ratio, 2.07; 95{\%} confidence interval, 1.11-3.88; P =.023), and > 20 pack-years of smoking (odds ratio, 2.61; 95{\%} confidence interval, 1.14-5.97; P =.023). Conclusions: There was no difference in almost any postoperative measure of intraoperative and postoperative complication in segmentectomy and lobectomy patients, except more air leakage was observed in the segmentectomy arm. Segmentectomy will be a standard treatment if the superior pulmonary function and noninferiority in overall survival are confirmed.",
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author = "{West Japan Oncology Group} and {Japan Clinical Oncology Group} and Kenji Suzuki and Hisashi Saji and Keiju Aokage and Watanabe, {Shun ichi} and Morihito Okada and Junki Mizusawa and Ryu Nakajima and Masahiro Tsuboi and Shinichiro Nakamura and Kenichi Nakamura and Tetsuya Mitsudomi and Hisao Asamura",
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T2 - Safety results of a randomized trial

AU - West Japan Oncology Group

AU - Japan Clinical Oncology Group

AU - Suzuki, Kenji

AU - Saji, Hisashi

AU - Aokage, Keiju

AU - Watanabe, Shun ichi

AU - Okada, Morihito

AU - Mizusawa, Junki

AU - Nakajima, Ryu

AU - Tsuboi, Masahiro

AU - Nakamura, Shinichiro

AU - Nakamura, Kenichi

AU - Mitsudomi, Tetsuya

AU - Asamura, Hisao

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: No definitive comparisons of surgical morbidity between segmentectomy and lobectomy for non–small cell lung cancer have been reported. Methods: We conducted a randomized controlled trial to confirm the noninferiority of segmentectomy to lobectomy in regard to prognosis (trial No. JCOG0802/WJOG4607L). Patients with invasive peripheral non–small cell lung cancer tumor of a diameter ≤2 cm were randomized to undergo either lobectomy or segmentectomy. The primary end point was overall survival. Here, we have focused on morbidity and mortality. Predictors of surgical morbidity were evaluated by the mode of surgery. Segmentectomy was categorized into simple and complex. Simple segmentectomy was defined as segmental resection of the right or left segment 6, left superior, or lingular segment. Complex segmentectomy was resection of the other segment. This trial is registered with the University Hospital Medical Information Network–Clinical Trial Registry (UMIN000002317). Results: Between August 10, 2009, and October 21, 2014, 1106 patients (lobectomy n = 554 and segmentectomy n = 552)were enrolled. No mortality was noted. Complications (grade ≥ 2)occurred in 26.2% and 27.4% in the lobectomy and segmentectomy arms (P =.68), respectively. Fistula/pulmonary-lung (air leak)was detected in 21 (3.8%)and 36 (6.5%)patients in the lobectomy and segmentectomy arms (P =.04), respectively. Multivariable analysis revealed that predictors of pulmonary complications, including air leak and empyema (grade ≥ 2)were complex segmentectomy (vs lobectomy)(odds ratio, 2.07; 95% confidence interval, 1.11-3.88; P =.023), and > 20 pack-years of smoking (odds ratio, 2.61; 95% confidence interval, 1.14-5.97; P =.023). Conclusions: There was no difference in almost any postoperative measure of intraoperative and postoperative complication in segmentectomy and lobectomy patients, except more air leakage was observed in the segmentectomy arm. Segmentectomy will be a standard treatment if the superior pulmonary function and noninferiority in overall survival are confirmed.

AB - Background: No definitive comparisons of surgical morbidity between segmentectomy and lobectomy for non–small cell lung cancer have been reported. Methods: We conducted a randomized controlled trial to confirm the noninferiority of segmentectomy to lobectomy in regard to prognosis (trial No. JCOG0802/WJOG4607L). Patients with invasive peripheral non–small cell lung cancer tumor of a diameter ≤2 cm were randomized to undergo either lobectomy or segmentectomy. The primary end point was overall survival. Here, we have focused on morbidity and mortality. Predictors of surgical morbidity were evaluated by the mode of surgery. Segmentectomy was categorized into simple and complex. Simple segmentectomy was defined as segmental resection of the right or left segment 6, left superior, or lingular segment. Complex segmentectomy was resection of the other segment. This trial is registered with the University Hospital Medical Information Network–Clinical Trial Registry (UMIN000002317). Results: Between August 10, 2009, and October 21, 2014, 1106 patients (lobectomy n = 554 and segmentectomy n = 552)were enrolled. No mortality was noted. Complications (grade ≥ 2)occurred in 26.2% and 27.4% in the lobectomy and segmentectomy arms (P =.68), respectively. Fistula/pulmonary-lung (air leak)was detected in 21 (3.8%)and 36 (6.5%)patients in the lobectomy and segmentectomy arms (P =.04), respectively. Multivariable analysis revealed that predictors of pulmonary complications, including air leak and empyema (grade ≥ 2)were complex segmentectomy (vs lobectomy)(odds ratio, 2.07; 95% confidence interval, 1.11-3.88; P =.023), and > 20 pack-years of smoking (odds ratio, 2.61; 95% confidence interval, 1.14-5.97; P =.023). Conclusions: There was no difference in almost any postoperative measure of intraoperative and postoperative complication in segmentectomy and lobectomy patients, except more air leakage was observed in the segmentectomy arm. Segmentectomy will be a standard treatment if the superior pulmonary function and noninferiority in overall survival are confirmed.

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KW - intentional sublobar resection

KW - morbidity

KW - prognosis

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