While thoracoscopic sub-lobar resection (SR) appears to result in similar oncologic outcomes compared with thoracoscopic lobectomy resection (LR), thoracoscopic SR may be a safer, more feasible surgical approach for geriatric patients with pathologic stage I non-small cell lung cancer (NSCLC), according to findings published in Frontiers in Oncology.

Comparing SR & LR Outcomes

While lung cancer occurs frequently among elderly adults, the preferred strategy for resection remains a matter of debate. Thus, Young-Jen Lin (Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine), and colleagues assessed survival and perioperative outcomes following thoracoscopic LR or SR in patients aged 75 and older with pathologic stage I NSCLC.

The researchers retrospectively analyzed 258 consecutive patients from a single center between 2011 and 2018, with a mean follow-up of 39.8 months. Patients had a mean age of 78.6±3.3; 57% were female, and 79.5% were non-smokers.

More patients underwent SR (N=174; 67.4%) than LR (N=84; 32.6%). Participants in the LR group were younger, with better performance status, larger tumors, and deeper tumor locations.

Better Perioperative Outcomes With Sub-Lobar Resection

Multivariate analyses demonstrated that resection method did not serve as a prognostic factor for overall survival (OS), and two groups paired according to propensity score matching did not demonstrate significant differences regarding lung cancer-specific OS, non-lung cancer-specific OS, and disease-free survival. However, SR helped attain better perioperative outcomes than LR, including less post-operative complications (10.0% vs 28.3%; P=0.011), reduced operative times (P<0.001), less blood loss (P=0.026), and briefer chest tube duration (P=0.010) and hospital stays (P=0.035). Severe post-operative complications were also less likely in the SR group than in the LR group (10.0% vs 25.0%; P=0.031).

The investigators noted that several recent studies have demonstrated no significant difference in clinical outcomes with SR compared with LR, and that SR may be an acceptable procedure for geriatric patients with clinical, stage I NSCLC. They also wrote that their study is the first to compare these two procedures in geriatric patients with early NSCLC and that their results confirm those of prior studies. However, they acknowledged several limitations of their findings, including the retrospective design and a cohort that included only Asian patients, adding that the results should be validated in prospective, multicenter studies.