Sublobar Resection for Non-Small Cell Lung Cancer in Octogenarians: A Prospective, Multicenter Study

• DOI: 10.1016/j.athoracsur.2023.02.061
• Publication Date: 2023-03-31T18:34:12Z
• Authors: Takahiro Mimae; Hisashi Saji; Hiroshige Nakamura; Norihito Okumura; Masanori Tsuchida; Makoto Sonobe; Takuro Miyazaki; Keiju Aokage; Masayuki Nakao; Tomohiro Haruki; Morihito Okada; Kenji Suzuki; Ichiro Yoshino
• Keywords: Aged, 80 and over; Lung Neoplasms; Octogenarians; Carcinoma, Non-Small-Cell Lung; Humans; Pneumonectomy; Small Cell Lung Carcinoma; 3. Good health; Neoplasm Staging; Retrospective Studies

Segmentectomy is a good surgical option for peripheral, early, non-small cell lung cancer (NSCLC) ≤2 cm. However, the role of sublobar resection including wedge resection and segmentectomy remains unclear for octogenarians with >2-cm but ≤4-cm early-stage NSCLC, for which lobectomy is a standard treatment.By use of a prospective registry, 892 patients aged ≥80 years with operable lung cancer were enrolled at 82 institutions. Of these, we analyzed the clinicopathologic findings and surgical outcomes of 419 patients with NSCLC tumors of 2 to 4 cm during a median follow-up of 50.9 months between April 2015 and December 2016.Five-year overall survival (OS) was slightly but not significantly worse after sublobar resection than after lobectomy in the entire cohort (54.7% [95% CI, 43.2%-93.0%] vs 66.8% [95% CI, 60.8%-72.1%]; P = .09). Multivariable Cox regression analysis of OS revealed that these surgical procedures were not independent prognostic predictors (hazard ratio, 0.8 [0.5-1.1]; P = .16). The 5-year OS was comparable between 192 patients who could tolerate lobectomy but were treated by sublobar resection or lobectomy (67.5% [95% CI, 48.8%-80.6%] vs 71.5% [95% CI, 62.9%-78.4%]; P = .79). Recurrence after sublobar resection and lobectomy was locoregional in 11 (11%) of 97 and in 23 (7%) of 322 patients, respectively.OS might be equivalent between sublobar resection with a secure surgical margin and lobectomy for selected patients aged ≥80 years with peripheral early-stage NSCLC tumors of 2 to 4 cm who can tolerate lobectomy.