Anatomic resection has superior long-term survival compared with wedge resection for second primary lung cancer after prior lobectomy

TY - JOUR

T1 - Anatomic resection has superior long-term survival compared with wedge resection for second primary lung cancer after prior lobectomy

AU - Baig, Mirza Zain

AU - Razi, Syed S.

AU - Stroever, Stephanie

AU - Weber, Joanna F.

AU - Connery, Cliff P.

AU - Bhora, Faiz Y.

N1 - Publisher Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

PY - 2021/5/1

Y1 - 2021/5/1

N2 - OBJECTIVES: The extent of surgical resection for early-stage second primary lung cancer (SPLC) in patients with a previous lobectomy is unclear. We sought to compare anatomic lung resections (lobectomy and segmentectomy) and wedge resections for small peripheral SPLC using a population-based database. METHODS: The Surveillance, Epidemiology and End Results database was queried for all patients with <_2 cm peripheral SPLC diagnosed between 2004 and 2015 who underwent prior lobectomy for the first primary and surgical resection only for the SPLC. American College of Chest Physicians guidelines were used to classify SPLC. Kaplan–Meier analysis and multivariable Cox regression were used to compare overall survival. RESULTS: A total of 356 patients met the inclusion criteria with 203 (57%) treated with wedge resection and 153 (43%) treated with anatomic resection. Significantly better median survival was observed with anatomic resection than with wedge resection using a Kaplan–Meier analysis (124 vs 63 months; P < 0.001). With multivariable Cox regression, improved long-term survival was observed for anatomic resection (hazard ratio: 0.44, confidence interval: 0.27–0.70; P = 0.001). Improvement in survival was demonstrated with wedge resection when lymph node sampling was done. Lastly, we calculated the average treatment effect on the treated with inverse probability weighting for a subgroup of patients and found that those with wedge resection and lymph node sampling had shorter long-term survival times. CONCLUSIONS: Anatomic resections may provide better long-term survival than wedge resections for patients with early-stage peripheral SPLC after prior lobectomy. Significant improvement in survival was observed with wedge resection for SPLC when adequate lymph node dissection was performed.

AB - OBJECTIVES: The extent of surgical resection for early-stage second primary lung cancer (SPLC) in patients with a previous lobectomy is unclear. We sought to compare anatomic lung resections (lobectomy and segmentectomy) and wedge resections for small peripheral SPLC using a population-based database. METHODS: The Surveillance, Epidemiology and End Results database was queried for all patients with <_2 cm peripheral SPLC diagnosed between 2004 and 2015 who underwent prior lobectomy for the first primary and surgical resection only for the SPLC. American College of Chest Physicians guidelines were used to classify SPLC. Kaplan–Meier analysis and multivariable Cox regression were used to compare overall survival. RESULTS: A total of 356 patients met the inclusion criteria with 203 (57%) treated with wedge resection and 153 (43%) treated with anatomic resection. Significantly better median survival was observed with anatomic resection than with wedge resection using a Kaplan–Meier analysis (124 vs 63 months; P < 0.001). With multivariable Cox regression, improved long-term survival was observed for anatomic resection (hazard ratio: 0.44, confidence interval: 0.27–0.70; P = 0.001). Improvement in survival was demonstrated with wedge resection when lymph node sampling was done. Lastly, we calculated the average treatment effect on the treated with inverse probability weighting for a subgroup of patients and found that those with wedge resection and lymph node sampling had shorter long-term survival times. CONCLUSIONS: Anatomic resections may provide better long-term survival than wedge resections for patients with early-stage peripheral SPLC after prior lobectomy. Significant improvement in survival was observed with wedge resection for SPLC when adequate lymph node dissection was performed.

KW - Anatomic resection

KW - Lobectomy

KW - SPLC

KW - Second primary lung cancer

KW - Segmentectomy

KW - Wedge resection

UR - https://www.scopus.com/pages/publications/85106539104

U2 - 10.1093/ejcts/ezaa443

DO - 10.1093/ejcts/ezaa443

M3 - Article

C2 - 33332526

SN - 1010-7940

VL - 59

SP - 1014

EP - 1020

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

IS - 5

ER -