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Thorac Cardiovasc Surg 2022; 70(03): 217-232
DOI: 10.1055/s-0041-1726100
Review

Lobar versus Sublobar Resection in the Elderly for Early Lung Cancer: A Meta-Analysis

Josiah Ng   *
1   Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
,
Yoshio Masuda   *
1   Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
,
Jun Jie Ng
2   Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
3   Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
,
Lowell Leow 
2   Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
,
Andrew M. T. L. Choong
2   Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
3   Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
4   Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
,
Harish Mithiran
2   Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
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Abstract

Objectives We performed a systematic review and meta-analysis of outcomes of lobectomy versus sublobar resection in elderly patients (≥65) with stage 1 nonsmall cell lung carcinoma (NSCLC).

Methods We searched for relevant articles using a set of inclusion and exclusion criteria. Meta-analytic techniques were applied.

Results Twelve studies (n = 5834) were chosen. Our results indicate that in the elderly, lobectomy for stage 1 NSCLC confers a survival advantage over sublobar resection. Lobectomy patients had a lower risk of death within 5 years and lower odds of local cancer recurrence. Our results show that lobectomy had a better 5-year cancer-specific survival and 5-year disease-free survival that trended toward significance. The sublobar resection group showed better 30-day operative mortality that trended toward significance. Subgroup analysis of stage 1A cancer demonstrated no difference in 5-year overall survival rates. However, for stage 1B tumors 5-year overall survival favored lobectomy.

Conclusion Lobectomy for stage 1 NSCLC in elderly patients is superior to sublobar resection in terms of survival and cancer recurrence and should be afforded where possible. For stage 1A tumors, sublobar resection is noninferior and may be considered. Further randomized controlled trials in this topic is required.

Keywords

lobectomy - segmentectomy - lung cancer - elderly

Authors' Contribution

Joint first-authors Josiah Ng and Yoshio Masuda are medical students who contributed equally to the inception, discussion, and drafting of this paper. They have contributed equally to the registration, literature review, data extraction, data processing, and revision of the paper under the guidance of the senior authors. Their joint authorship is approved by the senior author.


* Joint first-authors.


Supplementary Material



Publication History

Received: 10 December 2020

Accepted: 29 January 2021

Article published online:
01 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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