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Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients?

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Abstract

Purposes

The aim of this study was to evaluate whether sublobar resection could achieve recurrence and survival rates equivalent to lobectomy in high-risk elderly patients.

Methods

We conducted a retrospective multicenter study that including all consecutive patients (aged >75 years) who underwent operation for clinical stage I non-small cell lung cancer (NSCLC). The clinicopathological data, postoperative morbidity and mortality, recurrence rate and vital status were retrieved. The overall survival, cancer-specific survival and disease-free survival were also assessed.

Results

Two hundred and thirty-nine patients (median age 78 years) were enrolled. Lobectomies were performed in 149 (62.3 %) patients and sublobar resections in 90 (39 segmentectomies, 51 wedge resections). There were no differences in the recurrence rates following lobar versus sublobar resections (19 versus 23 %, respectively; p = 0.5) or the overall survival (p = 0.1), cancer-specific survival (p = 0.3) or disease-free survival (p = 0.1). After adjusting for 1:1 propensity score matching and a matched pair analysis, the results remained unchanged. A tumor size >2 cm and pN2 disease were independent negative prognostic factors in unmatched (p = 0.01 and p = 0.0003, respectively) and matched (p = 0.02 and p = 0.005, respectively) analyses.

Conclusions

High-risk elderly patients may benefit from sublobar resection, which provides an equivalent long-term survival compared to lobectomy.

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Acknowledgments

The authors declare that they have no conflicts of interest and received no funding for the present paper.

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Authors and Affiliations

  1. Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy

    Alfonso Fiorelli & Mario Santini

  2. Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy

    Francesco Paolo Caronia

  3. Thoracic Surgery Unit, University of Bologna, Bologna, Italy

    Niccolò Daddi & Sandro Mattioli

  4. Thoracic Surgery Unit, University of Foggia, Foggia, Italy

    Domenico Loizzi, Nicoletta Ardò & Francesco Sollitto

  5. Thoracic Surgery Unit, University of Parma, Parma, Italy

    Luca Ampollini, Luigi Ventura & Paolo Carbognani

  6. Thoracic Surgery Unit, University of Perugia, Perugia, Italy

    Rossella Potenza & Francesco Puma

  7. Thoracic Surgery Unit, San Luigi Hospital, University of Turin, Turin, Italy

    Francesco Ardissone

  8. Thoracic Surgery Unit, University of Terni, Terni, Italy

    Mark Ragusa

Authors
  1. Alfonso Fiorelli
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  2. Francesco Paolo Caronia
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  9. Rossella Potenza
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  11. Francesco Sollitto
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  12. Sandro Mattioli
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  13. Francesco Puma
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  14. Mario Santini
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Correspondence to Alfonso Fiorelli.

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Fiorelli, A., Caronia, F.P., Daddi, N. et al. Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients?. Surg Today 46, 1370–1382 (2016). https://doi.org/10.1007/s00595-016-1314-8

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  • DOI: https://doi.org/10.1007/s00595-016-1314-8

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