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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-small cell lung cancer &#40;NSCLC&#41; remains the leading cause of cancer death worldwide&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> especially in patients with chronic respiratory diseases such as chronic obstructive pulmonary disease &#40;COPD&#41;&#46; In recent decades&#44; however&#44; efforts to prevent&#44; diagnose&#44; and treat NSCLC have led to a decline in age-adjusted mortality rates &#40;especially in men&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> and the detection of smaller tumors at the time of diagnosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Today&#44; the treatment of choice for small NSCLC tumors is surgical resection by lobectomy combined with lymph node dissection&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> preferably by video-assisted thoracic surgery &#40;VATS&#41;&#46; NSCLC treatment practice guidelines recommend the use of sublobar resections such as segmentectomy only in patients who would not tolerate lobectomy due to poor lung function or comorbidities&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; the results of the JCOG0802 study&#44; a multicenter randomized clinical trial in a Japanese population of patients with stage IA NSCLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm and a consolidation-to-tumor ratio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5<span class="elsevierStyleHsp" style=""></span>cm have recently been published&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> In this phase III trial&#44; the authors randomized more than 1000 participants to a segmentectomy arm or a lobectomy arm&#44; with the primary objective of demonstrating the non-inferiority of overall survival after segmentectomy versus lobectomy&#46; After a mean follow-up of more than 7 years&#44; the authors found that segmentectomy was superior to lobectomy in overall 5-year survival &#40;94&#46;3&#37; vs 91&#46;1&#44; HR 0&#46;663&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; and showed a similar 5-year recurrence-free survival rate &#40;88&#46;0&#37; vs 87&#46;9&#37;&#41; and a higher rate of local recurrences &#40;10&#46;5&#37; vs 5&#46;4&#37;&#41;&#46; Surprisingly&#44; improved survival in the segmentectomy group appeared to be due to a decrease in deaths from a second cancer and&#44; to a lesser extent&#44; from non-cancer diseases&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The results of this study have generated great interest among the scientific community since it was first reported in 2021&#44; but doubts have also emerged surrounding the resulting paradigm shift in the surgical treatment of NSCLC&#46; Is this study sufficiently robust to prompt the medical community and stakeholders to change their guidelines and recommend segmentectomy as the procedure of choice for the surgical treatment of NSCLC&#63; Several previously published studies support the benefit of segmentectomy versus lobectomy reported by Saji and colleagues&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A retrospective study<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> of 312 patients with clinical stage IA NSCLC published in 2016 compared outcomes of patients undergoing segmentectomy or pulmonary lobectomy&#44; and found similar 5-year and 10-year survival in both groups&#46; Specifically&#44; oncologic outcomes after segmentectomy were slightly better than after lobectomy&#44; with the first group obtaining 5- and 10-year survival rates of 97&#46;5&#37; and 83&#46;5&#37;&#44; respectively&#44; compared with 87&#46;75&#37; and 75&#46;0&#37; in the lobectomy group&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2017&#44; a systematic review based on retrospective data from 24&#44;542 patients found that survival in patients with stage I NSCLC who underwent therapeutic segmentectomies did not vary from patients who underwent lobectomies&#44; with a hazard ratio &#40;relative risk&#41; of 1&#46;04 &#40;95&#37; confidence interval 0&#46;92&#8211;1&#46;18&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;50&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A more recent systematic review and meta-analysis that included 16 studies concluded that lobectomy has an overall survival similar to segmentectomy and superior to wedge resection&#46; These results led the authors to suggest that segmentectomy should be positioned as a valuable alternative for patients with NSCLC smaller than 2<span class="elsevierStyleHsp" style=""></span>cm&#44; and that wedge resection should be avoided whenever possible&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; a recently published retrospective analysis of data from a reference center in the USA concluded that there were no differences in clinical outcomes &#40;5-year mortality&#44; recurrence&#44; or recurrence-free survival&#41; between anatomic segmentectomy and lobectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the evidence from the above studies and from the JCOG0802 study group&#44; it seems clear that segmentectomy should be positioned as the surgical procedure of choice for patients with early-stage NSCLC&#44; as it offers better survival than lobectomy and greater preservation of pulmonary parenchyma&#44; despite a greater proportion of local relapses in the follow-up&#46; Systematic nodal dissection can be performed with segmentectomy in a manner similar to that of lobectomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The findings of this study are only applicable to peripheral NSCLC measuring less than 2<span class="elsevierStyleHsp" style=""></span>cm in diameter&#44; but this is precisely the area where diagnostic rates are increasing&#44; especially as a result of lung cancer screening programs in at-risk populations&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Furthermore&#44; as the target population for lung cancer screening consists predominantly of patients with COPD and previous emphysema&#44; procedures of this type will be performed more frequently because patients who otherwise would not be eligible for lobectomy can be included&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">However&#44; it is also important to bear in mind that segmentectomy is a technically more complex procedure than lobectomy and requires more prolonged surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> This means that more operating rooms will be needed to allow hospitals to continue offering patients the shortest possible surgery waiting time&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion&#44; the results of the JCOG0802 study denote a clear change of mindset in the treatment of early-stage NSCLC &#40;stage IA&#41;&#44; reinforcing the idea that at least in this type of tumor&#44; resection of a smaller amount of tissue may improve life expectancy&#46; The details of this study still have to be thoroughly analyzed&#44; but we hope that this new evidence will soon be incorporated into the clinical practice guidelines&#46; Perhaps a new day has dawned&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">JIDV declares no conflicts of interest&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">GRR declares no conflicts of interest&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">BAN has received payments for scientific consultancy and&#47;or activities in the last 3 years from AstraZeneca&#44; Laboratories Bial&#44; Boehringer Ingelheim&#44; Chiesi&#44; Gilead&#44; GSK&#44; Laboratories Menarini&#44; MSD&#44; and Novartis AG&#46;</p></span></span>"
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Editorial
Segmentectomy in Lung Cancer as a New Standard of Treatment: Can Less Be More?
Jesus Isea de la Viñaa, Gema Ramírez-Rodríguezb,
Corresponding author
, Bernardino Alcázar-Navarreteb,c,d
a Thoracic Surgery Unit, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
b Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
c Departamento de Medicina, Universidad de Granada, Spain
d IBS-Granada, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-small cell lung cancer &#40;NSCLC&#41; remains the leading cause of cancer death worldwide&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> especially in patients with chronic respiratory diseases such as chronic obstructive pulmonary disease &#40;COPD&#41;&#46; In recent decades&#44; however&#44; efforts to prevent&#44; diagnose&#44; and treat NSCLC have led to a decline in age-adjusted mortality rates &#40;especially in men&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> and the detection of smaller tumors at the time of diagnosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Today&#44; the treatment of choice for small NSCLC tumors is surgical resection by lobectomy combined with lymph node dissection&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> preferably by video-assisted thoracic surgery &#40;VATS&#41;&#46; NSCLC treatment practice guidelines recommend the use of sublobar resections such as segmentectomy only in patients who would not tolerate lobectomy due to poor lung function or comorbidities&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; the results of the JCOG0802 study&#44; a multicenter randomized clinical trial in a Japanese population of patients with stage IA NSCLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm and a consolidation-to-tumor ratio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5<span class="elsevierStyleHsp" style=""></span>cm have recently been published&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> In this phase III trial&#44; the authors randomized more than 1000 participants to a segmentectomy arm or a lobectomy arm&#44; with the primary objective of demonstrating the non-inferiority of overall survival after segmentectomy versus lobectomy&#46; After a mean follow-up of more than 7 years&#44; the authors found that segmentectomy was superior to lobectomy in overall 5-year survival &#40;94&#46;3&#37; vs 91&#46;1&#44; HR 0&#46;663&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; and showed a similar 5-year recurrence-free survival rate &#40;88&#46;0&#37; vs 87&#46;9&#37;&#41; and a higher rate of local recurrences &#40;10&#46;5&#37; vs 5&#46;4&#37;&#41;&#46; Surprisingly&#44; improved survival in the segmentectomy group appeared to be due to a decrease in deaths from a second cancer and&#44; to a lesser extent&#44; from non-cancer diseases&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The results of this study have generated great interest among the scientific community since it was first reported in 2021&#44; but doubts have also emerged surrounding the resulting paradigm shift in the surgical treatment of NSCLC&#46; Is this study sufficiently robust to prompt the medical community and stakeholders to change their guidelines and recommend segmentectomy as the procedure of choice for the surgical treatment of NSCLC&#63; Several previously published studies support the benefit of segmentectomy versus lobectomy reported by Saji and colleagues&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A retrospective study<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> of 312 patients with clinical stage IA NSCLC published in 2016 compared outcomes of patients undergoing segmentectomy or pulmonary lobectomy&#44; and found similar 5-year and 10-year survival in both groups&#46; Specifically&#44; oncologic outcomes after segmentectomy were slightly better than after lobectomy&#44; with the first group obtaining 5- and 10-year survival rates of 97&#46;5&#37; and 83&#46;5&#37;&#44; respectively&#44; compared with 87&#46;75&#37; and 75&#46;0&#37; in the lobectomy group&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2017&#44; a systematic review based on retrospective data from 24&#44;542 patients found that survival in patients with stage I NSCLC who underwent therapeutic segmentectomies did not vary from patients who underwent lobectomies&#44; with a hazard ratio &#40;relative risk&#41; of 1&#46;04 &#40;95&#37; confidence interval 0&#46;92&#8211;1&#46;18&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;50&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A more recent systematic review and meta-analysis that included 16 studies concluded that lobectomy has an overall survival similar to segmentectomy and superior to wedge resection&#46; These results led the authors to suggest that segmentectomy should be positioned as a valuable alternative for patients with NSCLC smaller than 2<span class="elsevierStyleHsp" style=""></span>cm&#44; and that wedge resection should be avoided whenever possible&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; a recently published retrospective analysis of data from a reference center in the USA concluded that there were no differences in clinical outcomes &#40;5-year mortality&#44; recurrence&#44; or recurrence-free survival&#41; between anatomic segmentectomy and lobectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the evidence from the above studies and from the JCOG0802 study group&#44; it seems clear that segmentectomy should be positioned as the surgical procedure of choice for patients with early-stage NSCLC&#44; as it offers better survival than lobectomy and greater preservation of pulmonary parenchyma&#44; despite a greater proportion of local relapses in the follow-up&#46; Systematic nodal dissection can be performed with segmentectomy in a manner similar to that of lobectomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The findings of this study are only applicable to peripheral NSCLC measuring less than 2<span class="elsevierStyleHsp" style=""></span>cm in diameter&#44; but this is precisely the area where diagnostic rates are increasing&#44; especially as a result of lung cancer screening programs in at-risk populations&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Furthermore&#44; as the target population for lung cancer screening consists predominantly of patients with COPD and previous emphysema&#44; procedures of this type will be performed more frequently because patients who otherwise would not be eligible for lobectomy can be included&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">However&#44; it is also important to bear in mind that segmentectomy is a technically more complex procedure than lobectomy and requires more prolonged surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> This means that more operating rooms will be needed to allow hospitals to continue offering patients the shortest possible surgery waiting time&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion&#44; the results of the JCOG0802 study denote a clear change of mindset in the treatment of early-stage NSCLC &#40;stage IA&#41;&#44; reinforcing the idea that at least in this type of tumor&#44; resection of a smaller amount of tissue may improve life expectancy&#46; The details of this study still have to be thoroughly analyzed&#44; but we hope that this new evidence will soon be incorporated into the clinical practice guidelines&#46; Perhaps a new day has dawned&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">JIDV declares no conflicts of interest&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">GRR declares no conflicts of interest&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">BAN has received payments for scientific consultancy and&#47;or activities in the last 3 years from AstraZeneca&#44; Laboratories Bial&#44; Boehringer Ingelheim&#44; Chiesi&#44; Gilead&#44; GSK&#44; Laboratories Menarini&#44; MSD&#44; and Novartis AG&#46;</p></span></span>"
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Article information
ISSN: 03002896
Original language: English
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