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Meta‐analysis of lobectomy, segmentectomy, and wedge resection for stage I non‐small cell lung cancer
Author(s) -
Zhang Yang,
Sun Yihua,
Wang Rui,
Ye Ting,
Zhang Yiliang,
Chen Haiquan
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23800
Subject(s) - medicine , wedge resection , lung cancer , pneumonectomy , stage (stratigraphy) , surgery , carcinoma , resection , paleontology , biology
Background Survival difference following lobectomy, segmentectomy, and wedge resection in stage I non‐small cell lung cancer (NSCLC) and its subgroups remains undetermined. Methods We systemically searched published articles comparing recurrence‐free survival (RFS), overall survival (OS), or cancer‐specific survival (CSS) between lobectomy and limited resection or between segmentectomy and wedge resection. Results A total of 42 studies published from 1980 to 2014 enrolling 21,926 patients were included in this meta‐analysis. Survival results favored lobectomy in stage IA NSCLC ≤2 cm (combined HR: 1.530, 95% CI: 1.402–1.671, P < 0.001) or patient's ≥65 years old (combined HR: 1.227, 95% CI: 1.003–1.502, P = 0.047). Survival outcome of video‐assisted thoracoscopic (VATS) sublobectomy was comparable to that of VATS lobectomy (pooled HR: 0.808, 95% CI: 0.556–1.174, P = 0.263). The combined HR of segmentectomy versus lobectomy was 1.231 (95% CI: 1.070–1.417, P = 0.004), while the pooled HR of wedge resection versus segmentectomy was 1.542 (95% CI: 0.856–2.780, P = 0.149). Conclusions This study suggested that tumor size or age alone should not be the criteria to encourage sublobar resection. For stage I NSCLC, survival following segmentectomy was inferior to lobectomy. Patients undergoing intentional sublobectomy achieved comparable survival as those who received lobectomy. J. Surg. Oncol. 2015 111:334–340 . © 2014 Wiley Periodicals, Inc.