Perioperative and long-term outcomes of segmentectomy for ground-glass opacity dominant early stage lung cancer: A single-center large-sample retrospective analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Zhenyu , LIU Chengwu , MEI Jiandong , ZHOU Jian , ZHU Yunke , LIN Feng , LIAO Hu , MA Lin , LIU Zheng , GUO Chenglin , PU Qiang ,  LIU Lunxu

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Segmentectomy; ground-glass opacity; lung cancer; prognosis; surgery

DOI：

10.7507/1007-4848.202111030

Video：

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Objective To summarize the perioperative and long-term outcomes of ground-glass opacity (GGO) dominant early stage lung cancer patients treated by anatomic segmentectomy. Methods We collected clinical data of 756 patients from Western China Lung Cancer Database, who underwent intentional anatomic segmentectomy [tumor size (T) ≤ 2 cm, GGO ≥ 50%] in the Department of Thoracic Surgery, West China Hospital, Sichuan University from 2009 to 2018. There were 233 males and 523 females at a median age of 53 (25-83) years including 290 (38.4%) patients of simple segmentectomy and 466 (61.6%) patients of complex segmentectomy. All patients were diagnosed as adenocarcinoma, including 338 (44.7%) patients of minimally invasive adenocarcinoma and 418 (55.3%) patients of invasive adenocarcinoma. Results The median operative time was 115 (38-300) min, the median blood loss was 20 (5-800) mL, 58 (7.7%) patients had postoperative complications and the postoperative stay was 4 (2-24) days. The median follow-up period was 43.0 (30.1-167.9) months. Five-year overall survival rate was 99.5% [95%CI (98.8%, 100.0%)], 5-year recurrence-free survival rate was 98.8% [95%CI (97.5%, 100.0%)], and 5-year lung cancer-specific survival rate was 100.0%. Conclusion Anatomic segmentectomy has favorable perioperative outcomes and excellent prognosis in GGO dominant early stage lung cancer patients.

Citation： YANG Zhenyu, LIU Chengwu, MEI Jiandong, ZHOU Jian, ZHU Yunke, LIN Feng, LIAO Hu, MA Lin, LIU Zheng, GUO Chenglin, PU Qiang, LIU Lunxu. Perioperative and long-term outcomes of segmentectomy for ground-glass opacity dominant early stage lung cancer: A single-center large-sample retrospective analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1420-1426. doi: 10.7507/1007-4848.202111030 Copy

1.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2.	National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3.	Chen K, Bai J, Reuben A, et al. Multiomics analysis reveals distinct immunogenomic features of lung cancer with ground-glass opacity. Am J Respir Crit Care Med, 2021, [Epub ahead of print].
4.	Hattori A, Hirayama S, Matsunaga T, et al. Distinct clinicopathologic characteristics and prognosis based on the presence of ground glass opacity component in clinical stage ⅠA lung adenocarcinoma. J Thorac Oncol, 2019, 14(2): 265-275.
5.	Zhang Y, Ma X, Shen X, et al. Surgery for pre- and minimally invasive lung adenocarcinoma. J Thorac Cardiovasc Surg, 2020, [Epub ahead of print].
6.	Ito H, Suzuki K, Mizutani T, et al. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg, 2020, [Epub ahead of print].
7.	Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stageⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
8.	Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer? Gen Thorac Cardiovasc Surg, 2020, 68(7): 703-706.
9.	Landreneau RJ, Normolle DP, Christie NA, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stageⅠnon-small-cell lung cancer: A propensity-matched analysis. J Clin Oncol, 2014, 32(23): 2449-2455.
10.	Tane S, Nishio W, Nishioka Y, et al. Evaluation of the residual lung function after thoracoscopic segmentectomy compared with lobectomy. Ann Thorac Surg, 2019, 108(5): 1543-1550.
11.	Oncology. NCCN clinical practice guidelines in non-small cell lung cancer, Version 5. 2021. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Published 2021. Accessed on 2021-10-06.
12.	Eguchi T, Sato T, Shimizu K. Technical advances in segmentectomy for lung cancer: A minimally invasive strategy for deep, small, and impalpable tumors. Cancers (Basel), 2021, 13(13): 3137.
13.	Liu C, Liao H, Guo C, et al. Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg, 2020, 160(6): 1586-1594.
14.	Pu Q, Liu C, Guo C, et al. Stem-Branch: A novel method for tracking the anatomy during thoracoscopic S9-10 segmentectomy. Ann Thorac Surg, 2019, 108(5): e333-e335.
15.	Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: Application of Stem-Branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
16.	Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
17.	Jones GD, Caso R, Choe G, et al. Intentional segmentectomy for clinical T1 N0 non-small cell lung cancer: Survival differs by segment. Ann Thorac Surg, 2021, 111(3): 1028-1035.
18.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
19.	Zhao ZR, Situ DR, Lau RWH, et al. Comparison of segmentectomy and lobectomy in stageⅠA adenocarcinomas. J Thorac Oncol, 2017, 12(5): 890-896.
20.	Onaitis MW, Furnary AP, Kosinski AS, et al. Equivalent survival between lobectomy and segmentectomy for clinical stage ⅠA lung cancer. Ann Thorac Surg, 2020, 110(6): 1882-1891.
21.	Dziedzic R, Zurek W, Marjanski T, et al. Stage Ⅰnon-small-cell lung cancer: Long-term results of lobectomy versus sublobar resection from the Polish National Lung Cancer Registry. Eur J Cardiothorac Surg, 2017, 52(2): 363-369.
22.	Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
23.	Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinicalⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
24.	Fu F, Zhang Y, Wen Z, et al. Distinct prognostic factors in patients with stageⅠnon-small cell lung cancer with radiologic part-solid or solid lesions. J Thorac Oncol, 2019, 14(12): 2133-2142.
25.	Chiang XH, Lu TP, Hsieh MS, et al. Thoracoscopic wedge resection versus segmentectomy for cT1N0 lung adenocarcinoma. Ann Surg Oncol, 2021,Epub ahead of print.
26.	Hisashi S, Morihito O, Masahiro T, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L): A multicentre, randomised, controlled, phase 3 trial. Available at SSRN http://dxdoiorg/102139/ssrn3918871. Accessed on 2021-11-06.
27.	Zhong C, Sakurai H, Wei S, et al. Sublobar resections for small-sized stageⅠa lung adenocarcinoma: A Sino-Japanese multicenter study. J Thorac Dis, 2018, 10(2): 991-998.
28.	Im DJ, Lee SM, Han K, et al. Predictive factors of recurrence after resection of subsolid clinical stageⅠA lung adenocarcinoma. Thorac Cancer, 2021, 12(6): 941-948.
29.	Tsutani Y, Handa Y, Shimada Y, et al. Comparison of cancer control between segmentectomy and wedge resection in patients with clinical stageⅠA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 162(4): 1244-1252.
30.	Kumar A, Deng JZ, Raman V, et al. A national analysis of minimally invasive vs. open segmentectomy for stageⅠA non-small-cell lung cancer. Semin Thorac Cardiovasc Surg, 2021, 33(2): 535-544.
31.	Dell'Amore A, Lomangino I, Cannone G, et al. Comparison of operative and postoperative characteristics and outcomes between thoracoscopic segmentectomy and lobectomy for non-small-cell lung cancer: A propensity score matching study from the Italian VATS Group Registry. Eur J Cardiothorac. Eur J Cardiothorac Surg, 2021, [Epub ahead of print].
32.	Kneuertz PJ, Zhao J, D'Souza DM, et al. National trends and outcomes of segmentectomy in the Society of Thoracic Surgery Database. Ann Thorac Surg, 2021, [Epub ahead of print].

1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
2. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3. Chen K, Bai J, Reuben A, et al. Multiomics analysis reveals distinct immunogenomic features of lung cancer with ground-glass opacity. Am J Respir Crit Care Med, 2021, [Epub ahead of print].
4. Hattori A, Hirayama S, Matsunaga T, et al. Distinct clinicopathologic characteristics and prognosis based on the presence of ground glass opacity component in clinical stage ⅠA lung adenocarcinoma. J Thorac Oncol, 2019, 14(2): 265-275.
5. Zhang Y, Ma X, Shen X, et al. Surgery for pre- and minimally invasive lung adenocarcinoma. J Thorac Cardiovasc Surg, 2020, [Epub ahead of print].
6. Ito H, Suzuki K, Mizutani T, et al. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg, 2020, [Epub ahead of print].
7. Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stageⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
8. Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer? Gen Thorac Cardiovasc Surg, 2020, 68(7): 703-706.
9. Landreneau RJ, Normolle DP, Christie NA, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stageⅠnon-small-cell lung cancer: A propensity-matched analysis. J Clin Oncol, 2014, 32(23): 2449-2455.
10. Tane S, Nishio W, Nishioka Y, et al. Evaluation of the residual lung function after thoracoscopic segmentectomy compared with lobectomy. Ann Thorac Surg, 2019, 108(5): 1543-1550.
11. Oncology. NCCN clinical practice guidelines in non-small cell lung cancer, Version 5. 2021. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Published 2021. Accessed on 2021-10-06.
12. Eguchi T, Sato T, Shimizu K. Technical advances in segmentectomy for lung cancer: A minimally invasive strategy for deep, small, and impalpable tumors. Cancers (Basel), 2021, 13(13): 3137.
13. Liu C, Liao H, Guo C, et al. Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg, 2020, 160(6): 1586-1594.
14. Pu Q, Liu C, Guo C, et al. Stem-Branch: A novel method for tracking the anatomy during thoracoscopic S9-10 segmentectomy. Ann Thorac Surg, 2019, 108(5): e333-e335.
15. Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: Application of Stem-Branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
16. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
17. Jones GD, Caso R, Choe G, et al. Intentional segmentectomy for clinical T1 N0 non-small cell lung cancer: Survival differs by segment. Ann Thorac Surg, 2021, 111(3): 1028-1035.
18. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
19. Zhao ZR, Situ DR, Lau RWH, et al. Comparison of segmentectomy and lobectomy in stageⅠA adenocarcinomas. J Thorac Oncol, 2017, 12(5): 890-896.
20. Onaitis MW, Furnary AP, Kosinski AS, et al. Equivalent survival between lobectomy and segmentectomy for clinical stage ⅠA lung cancer. Ann Thorac Surg, 2020, 110(6): 1882-1891.
21. Dziedzic R, Zurek W, Marjanski T, et al. Stage Ⅰnon-small-cell lung cancer: Long-term results of lobectomy versus sublobar resection from the Polish National Lung Cancer Registry. Eur J Cardiothorac Surg, 2017, 52(2): 363-369.
22. Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
23. Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinicalⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
24. Fu F, Zhang Y, Wen Z, et al. Distinct prognostic factors in patients with stageⅠnon-small cell lung cancer with radiologic part-solid or solid lesions. J Thorac Oncol, 2019, 14(12): 2133-2142.
25. Chiang XH, Lu TP, Hsieh MS, et al. Thoracoscopic wedge resection versus segmentectomy for cT1N0 lung adenocarcinoma. Ann Surg Oncol, 2021,Epub ahead of print.
26. Hisashi S, Morihito O, Masahiro T, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L): A multicentre, randomised, controlled, phase 3 trial. Available at SSRN http://dxdoiorg/102139/ssrn3918871. Accessed on 2021-11-06.
27. Zhong C, Sakurai H, Wei S, et al. Sublobar resections for small-sized stageⅠa lung adenocarcinoma: A Sino-Japanese multicenter study. J Thorac Dis, 2018, 10(2): 991-998.
28. Im DJ, Lee SM, Han K, et al. Predictive factors of recurrence after resection of subsolid clinical stageⅠA lung adenocarcinoma. Thorac Cancer, 2021, 12(6): 941-948.
29. Tsutani Y, Handa Y, Shimada Y, et al. Comparison of cancer control between segmentectomy and wedge resection in patients with clinical stageⅠA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 162(4): 1244-1252.
30. Kumar A, Deng JZ, Raman V, et al. A national analysis of minimally invasive vs. open segmentectomy for stageⅠA non-small-cell lung cancer. Semin Thorac Cardiovasc Surg, 2021, 33(2): 535-544.
31. Dell'Amore A, Lomangino I, Cannone G, et al. Comparison of operative and postoperative characteristics and outcomes between thoracoscopic segmentectomy and lobectomy for non-small-cell lung cancer: A propensity score matching study from the Italian VATS Group Registry. Eur J Cardiothorac. Eur J Cardiothorac Surg, 2021, [Epub ahead of print].
32. Kneuertz PJ, Zhao J, D'Souza DM, et al. National trends and outcomes of segmentectomy in the Society of Thoracic Surgery Database. Ann Thorac Surg, 2021, [Epub ahead of print].

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Perioperative and long-term outcomes of segmentectomy for ground-glass opacity dominant early stage lung cancer: A single-center large-sample retrospective analysis

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