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Survival of Octogenarians with Early-Stage Non-small Cell Lung Cancer is Comparable Between Wedge Resection and Lobectomy/Segmentectomy: JACS1303

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Anatomic resection with lymph node dissection or sampling is the standard treatment for early non-small cell lung cancer (NSCLC), and wedge resection is an option for compromised patients. This study aimed to determine whether wedge resection can provide comparable prognoses for elderly patients with NSCLC.

Methods

The study analyzed the clinicopathologic findings and surgical outcomes during a median follow-up period of 39.6 months for 156 patients with solid dominant (consolidation-to-tumor ratio > 0.5) small (whole tumor size ≤ 2 cm) NSCLC among 892 patients 80 years of age or older with medically operable lung cancer between April 2015 and December 2016.

Results

The 3-year overall survival (OS) rates after wedge resection and after segmentectomy plus lobectomy did not differ significantly (86.5 %; 95 % confidence interval [CI], 74.6–93.0 % vs 83.7 % 95 % CI, 74.0–90.0 %; P = 0.92). Multivariable Cox regression analysis of OS with propensity scores showed that the surgical procedure was not an independent prognostic predictor (hazard ratio [HR], 0.84; 95 % CI, 0.39–1.8; P = 0.64). The 3-year OS rates were slightly better after wedge resection for 97 patients who could tolerate lobectomy than after segmentectomy plus lobectomy (89.4 %; 95 % CI, 73.8–95.9 % vs 75.8 %; 95 % CI, 62.0–85.2 %; P = 0.14). The cumulative incidence of other causes for death was marginally higher after segmentectomy plus lobectomy than after wedge resection (P = 0.079).

Conclusions

Wedge resection might be equivalent to lobectomy or segmentectomy for selected patients 80 years of age or older with early-stage NSCLC who can tolerate lobectomy.

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Acknowledgments

This study was supported by a Grant-in-Aid from the Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Kyoto, Japan and by grants from the Japan Society for the Promotion of Science (JSPS) KAKENHI (20K09177). The language in this report was proof-checked by a native English speaker with more than 25 years of experience in professionally editing medical manuscripts.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan

    Takahiro Mimae MD, PhD & Morihito Okada MD, PhD

  2. Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Hisashi Saji MD, PhD

  3. Division of General Thoracic Surgery, Tottori University Hospital, Tottori, Japan

    Hiroshige Nakamura MD, PhD & Tomohiro Haruki MD, PhD

  4. Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan

    Norihito Okumura MD, PhD

  5. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Masanori Tsuchida MD, PhD

  6. Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Makoto Sonobe MD, PhD

  7. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Takuro Miyazaki MD, PhD

  8. Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan

    Keiju Aokage MD, PhD

  9. Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Masayuki Nakao MD, PhD

  10. The Japanese Association for Chest Surgery, Committee for Scientific Affairs, Kyoto, Japan

    Morihito Okada MD, PhD & Kenji Suzuki MD, PhD

  11. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Kenji Suzuki MD, PhD

  12. Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga, Japan

    Masayuki Chida MD, PhD

  13. The Japanese Association for Chest Surgery, Kyoto, Japan

    Masayuki Chida MD, PhD

Authors
  1. Takahiro Mimae MD, PhD
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  2. Hisashi Saji MD, PhD
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  3. Hiroshige Nakamura MD, PhD
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  4. Norihito Okumura MD, PhD
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  5. Masanori Tsuchida MD, PhD
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  6. Makoto Sonobe MD, PhD
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  7. Takuro Miyazaki MD, PhD
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  8. Keiju Aokage MD, PhD
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  9. Masayuki Nakao MD, PhD
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  10. Tomohiro Haruki MD, PhD
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  11. Morihito Okada MD, PhD
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  12. Kenji Suzuki MD, PhD
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  13. Masayuki Chida MD, PhD
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Corresponding author

Correspondence to Hisashi Saji MD, PhD.

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Disclosure

Keiju Aokage gave lecture presentations for Mochida Pharmaceutical Co., Ltd, Astrazeneca, Covidien Japan, Taiho Parma, Bristol Myers Squibb, and Eli Lilly; gave seminar presentations for MSD; and did writing for Taiho Parma and Care-net.

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Mimae, T., Saji, H., Nakamura, H. et al. Survival of Octogenarians with Early-Stage Non-small Cell Lung Cancer is Comparable Between Wedge Resection and Lobectomy/Segmentectomy: JACS1303. Ann Surg Oncol 28, 7219–7227 (2021). https://doi.org/10.1245/s10434-021-09835-w

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  • DOI: https://doi.org/10.1245/s10434-021-09835-w

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