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Vol. 60. Issue 11.
Pages 705-713 (November 2024)
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Vol. 60. Issue 11.
Pages 705-713 (November 2024)
Original Article
Comparison of 5-Year Survival and Disease Recurrence After Trisegmentectomy or Left Upper Lobectomy: A Propensity Score Analysis of the National GEVATS Database
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Borja Aguinagaldea,b,c,
Corresponding author
, Juan A. Ferrer-Bonsomsd, Iker Lópeza,c, Ion Ander Lizarbea,c, Arantza Fernández-Mongea,c, José Luis Recueroe, Iñigo Royoe, Raúl Embúnf, GEVATS
a Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain
b Department of Surgery, UPV/EHU, Leioa, Spain
c Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
d Biomedical Engineering and Science Department, TECNUN, Universidad de Navarra, San Sebastian, Spain
e Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
f Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Universidad Zaragoza, Zaragoza, Spain
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Figures (4)
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Tables (6)
Table 1. Baseline Characteristics of Both Groups (Lobectomies and Segmentectomies) Prior to Propensity Score Matching.
Table 2. Cox Regression Survival Analysis for Each Variable Selected Separately, Prior to Propensity Score Matching.
Table 3. Variables Used for Propensity Score Matching for Each Type of Survival Analysis.
Table 4. Technical Factors, Complications and Hospital Stay of Overall Survival Analysis After Propensity Score Matching.
Table 5. Type of Recurrence in 189 Patients (126 Lobectomies and 63 Trisegmentectomies) Included in the Disease-free survival Analysis After Propensity Score Matching.
Table 6. Pattern of Recurrence in 45 Patients (30 Lobectomies and 15 Trisegmentectomies) Included in the Disease-free Survival Analysis After Propensity Score Matching in Subgroup of Patients With Tumors Measuring 20–30mm.
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Abstract
Introduction

Trisegmentectomy, or resection of the upper subdivision of the left upper lobe with preservation of the lingula, is considered by some authors to be equivalent to right upper lobectomy with middle lobe preservation.

Our objective was to compare survival and recurrence after trisegmentectomy versus left upper lobectomy procedures registered in the Spanish Video-Assisted Thoracic Surgery group (GEVATS) database.

Methods

We compared mortality, survival and recurrence in patients with left upper lobectomy or trisegmentectomy after propensity score matching for the following variables: age, smoking habit, tumor size, histologic type, radiological density of tumor, surgical access, forced expiratory volume in one second, diffusing capacity of the lungs for carbon monoxide, hypertension, chronic heart failure, ischemic heart disease, arrhythmia, stroke, peripheral vascular disease, diabetes and pre-surgery nodal status by positron emission tomography/computed tomography.

Results

A total of 540 left upper lobectomies and 83 trisegmentectomies were registered in the GEVATS database. After propensity score matching, 134 left upper lobectomies and 67 trisegmentectomies were selected. Survival outcomes were similar, but differences were found for recurrence (21.5% for trisegmentectomies vs. 35.4% for left upper lobectomies, p=0.05). Moreover, the recurrence patterns differed, with the lobectomy group showing a greater tendency to distant dissemination.

Conclusions

Trisegmentectomy and left upper lobectomy show similar 5-year survival rates. In our database, recurrence after trisegmentectomy was lower than after left upper lobectomy, while the recurrence pattern differed among the 2 surgical approaches, with a greater tendency to distant metastasis after left upper lobectomy.

Keywords:
Lung cancer
Trisegmentectomy
Left upper lobectomy
Survival
Segmentectomies
Sublobar resections

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