P174. Impact of margin distance and lymphadenectomy on recurrence after wedge resection versus segmentectomy for clinical stage IA non-small cell lung cancer
Copenhagen University
Copenhagen
Denmark - Contact Me
Professor of Cardiothoracic Surgery at the Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet.
He holds a PhD in the field of Video-Assisted Thoracoscopic Surgery (VATS) as well as a bachelor’s degree in Health Care Administration. His primary research focus is minimally invasive lung surgery, education and simulation in VATS and ERAS (Enhanced Recovery After Surgery). He is also conducting research in the fields of lung cancer screening and video-assisted thymectomy. Professor Petersen teaches regularly at the Faculty of Health and Medical Sciences, University of Copenhagen, and has experience supervising medical students for their master’s degree as well as PhD students.
For more than a decade Petersen has led clinical immersions at his centre with participation from clinics around the world and has proctored many thoracic surgeons around the world in VATS Lobectomy by a Standardized Anterior Approach.
He has given numerous lectures and educational seminars on VATS Lobectomy/segmentectomy, performed live surgery and presented at numerous international conferences. He has more than 160 publications in international peer-reviewed journals within the topics: VATS Lobectomy, VATS Segmentectomy, VATS Thymectomy, VATS Education and Simulation, Enhanced Recovery and Lung Cancer Screening.
He acts as a Director of Annual Meeting for the European Society of Thoracic Surgery (ESTS). Additionally, he is the ESTS co-chair for the ESTS/EACTS guidelines for surgical management of GGO lesions.
Description
Methods: We retrospectively reviewed prospectively collected data of patients who underwent thoracoscopic sublobar resection for cIA NSCLC from November 2016 to December 2023. Recurrence was analyzed using a time-to-event approach. Multivariable Cox regression analysis was performed to identify associations with recurrence-free survival (RFS). Propensity score matching (PSM) was applied to minimize bias in preoperative characteristics between the wedge resection and segmentectomy groups. The Kaplan-Meier method with the log-rank test and the Aalen-Johansen estimator with Gray's test were used to assess differences in RFS in the overall cohort and subgroups.
Results: A total of 334 patients were included, with 201 undergoing wedge resection and 133 undergoing segmentectomy. Multivariable analysis identified segmentectomy (hazard ratio [HR] 0.47, p = 0.003), margin distance ≥ 2.0 cm (HR 0.51, p = 0.016), ≥ 10 total lymph nodes (HR 0.33, p = 0.001), ≥ 1 N1 station (HR 0.49, 0.002), and ≥ 3 N2 stations (HR 0.67, p = 0.038) as predictive factors for improved RFS after sublobar resection. Margin-to-tumor ratio ≥ 1 was not a significant factor. The wedge resection group was less likely to achieve appropriate margin distance and lymph nodes dissection compared to the segmentectomy group both before and after PSM with p < 0.001. With a mean follow-up period of three years, the wedge resection group had poorer 5-year RFS compared to the segmentectomy group before PSM (45.8% vs. 76.6%, p <0.001) and after PSM (51.8% vs. 75.7%, p = 0.012). However, RFS was nearly similar between the two groups when margin distances were ≥ 2.0 cm, ≥ 10 total lymph nodes, or ≥ 3 N2 stations before PSM. After PSM, RFS remained comparable for margin distances ≥ 2.0 cm and ≥ 1 N1 stations. (Table 1) No significant difference was found in specific recurrence or cause of death between the two groups across all subgroups.
Conclusion: Segmentectomy offers superior survival compared to wedge resection for clinical stage IA NSCLC, with better resection margins, more extensive lymph node removal, and a lower recurrence rate. However, when margin distance and lymphadenectomy are optimized, wedge resection may achieve a comparable prognosis.
Authors
Lin Huang (1), Rene Petersen (1)
Institutions
(1) Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark