Outcomes and Survival for Early-Stage Non-Small Cell Lung Cancer Following Wedge Resection or Lobectomy: A Propensity Score-Matched Analysis Using a Novel Peruvian Registry
- Author:
Wildor Samir Cubas LLALLE
1
;
Franco ALBÁN-SÁNCHEZ
;
José TORRES-NEYRA
;
Wildor DONGO-MINAYA
;
Katherine INGA-MOYA
;
Johnny MAYTA
;
Juan VELÁSQUEZ
;
Jorge MANTILLA
;
Karen MENDOZA
;
Rafael VICUÑA
;
Victor MENDIZABAL
Author Information
- Publication Type:Clinical Research
- From: Journal of Chest Surgery 2024;57(6):501-510
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables.
Methods:This observational, analytical, longitudinal study used propensity scorematched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I–II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000–2020. After PSM, 650 cases were analyzed (resection, n=325;lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoregional-recurrence-free survival (LRFS).
Results:The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011).
Conclusion:Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.
