Segmental resection spares pulmonary function in patients with stage I lung cancer.

BACKGROUND Segmental resection for stage I non-small cell lung cancer remains controversial. Reports suggest that segmentectomy confers no advantage in preserving lung function and compromises survival. This study was undertaken to assess the validity of those assertions. METHODS We retrospectively analyzed patients undergoing lobectomy (n = 147) or segmentectomy (n = 54) for stage I non-small cell lung cancer between March 1996 and June 2001. All patients were included in the survival analysis. Pulmonary function testing was obtained preoperatively and at 1 year and included forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation, diffusing capacity, and stair-stepper exercise. Patients with recurrent disease (lobectomy, n = 32; segmentectomy, n = 10) were excluded in the pulmonary function testing analysis to avoid the confounding variables of tumor or treatments. RESULTS Preoperative pulmonary function tests in segmentectomy patients were significantly reduced compared with lobectomy (forced expiratory volume in 1 second, 75.1% versus 55.3%; p < 0.001). At 1 year, lobectomy patients experienced significant declines in forced vital capacity (85.5% to 81.1%), forced expiratory volume in 1 second (75.1% to 66.7%), maximum voluntary ventilation (72.8% to 65.2%), and diffusing capacity (79.3% to 69.6%). In contrast, a decline in diffusing capacity was the only significant change seen after segmental resection. Oxygen saturations at rest and with exercise were maintained in both groups. Actuarial survival in both groups was similar (p = 0.406) with a 1-year survival of 95% for lobectomy and 92% for segmentectomy. Four-year survivals were 67% and 62%, respectively. CONCLUSIONS For patients with stage I non-small cell lung cancer, segmental resection offers preservation of pulmonary function compared with lobectomy and does not compromise survival. Segmentectomy should be considered whenever permitted by anatomic location.

[1]  K. Sugimachi,et al.  Strategy for lymphadenectomy in lung cancer three centimeters or less in diameter. , 1990, The Annals of thoracic surgery.

[2]  W. Warren,et al.  Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. , 1994, The Journal of thoracic and cardiovascular surgery.

[3]  M. Okada,et al.  Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller? , 2001, The Annals of thoracic surgery.

[4]  R. Read,et al.  Survival after conservative resection for T1 N0 M0 non-small cell lung cancer. , 1990, The Annals of thoracic surgery.

[5]  T. Sakamoto,et al.  Analysis of lobectomy for small peripheral lung cancer supports extended segmentectomy. , 1998, The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi.

[6]  M. Higashiyama,et al.  Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study. , 1997, The Journal of thoracic and cardiovascular surgery.

[7]  V. Rusch,et al.  Lobectomy improves ventilatory function in selected patients with severe COPD. , 1998, The Annals of thoracic surgery.

[8]  R. Tsuchiya,et al.  Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy? , 1996, The Journal of thoracic and cardiovascular surgery.

[9]  K. Honma,et al.  Lymph node metastasis in small peripheral adenocarcinoma of the lung. , 1998, The Journal of thoracic and cardiovascular surgery.

[10]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[11]  M. Mack,et al.  Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer. , 1997, The Journal of thoracic and cardiovascular surgery.

[12]  M. Haga,et al.  Pulmonary function after segmentectomy for small peripheral carcinoma of the lung. , 1999, The Journal of thoracic and cardiovascular surgery.

[13]  J. Miller,et al.  Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. , 1987, The Annals of thoracic surgery.

[14]  L V Rubinstein,et al.  Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. , 1995, The Annals of thoracic surgery.

[15]  R. Ginsberg.  Editorial: Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas , 1996 .

[16]  H. Shennib,et al.  Sublobar resection for lung cancer. , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[17]  Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients. , 1985 .

[18]  N. Tsubota,et al.  Prospective study of extended segmentectomy for small lung tumors: the final report. , 2002, The Annals of thoracic surgery.

[19]  P. Pairolero,et al.  Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. , 2002, The Annals of thoracic surgery.