gms | German Medical Science

Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie

24.-26.10.2013, Basel, Schweiz

Split-lobe resections versus lobectomy for lung carcinoma of the left upper lobe: a pair-matched case-control study of clinical and oncological outcome

Meeting Abstract

  • B. Witte - Klinik für Thoraxchirurgie, Katholisches Klinikum Koblenz-Montabaur, Koblenz
  • M. Wolf - Klinik für Thoraxchirurgie, Katholisches Klinikum Koblenz-Montabaur, Koblenz
  • H. Hillebrand - Klinik für Thoraxchirurgie, Katholisches Klinikum Koblenz-Montabaur, Koblenz
  • M. Huertgen - Klinik für Thoraxchirurgie, Katholisches Klinikum Koblenz-Montabaur, Koblenz

Deutsche Gesellschaft für Thoraxchirurgie. Österreichische Gesellschaft für Thoraxchirurgie. Schweizerische Gesellschaft für Thoraxchirurgie. Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie. Basel, Schweiz, 24.-26.10.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocS1.1

doi: 10.3205/13dgt008, urn:nbn:de:0183-13dgt0087

Published: October 14, 2013

© 2013 Witte et al.
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Outline

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Objective: To compare left upper split-lobe procedures, being upper trisegmentectomy and resection of the lingula, to left upper lobectomy for surgical treatment of lung carcinoma originating from the left upper lobe.

Methods: Pair-matched control study comparing the clinical and oncological outcome of 22 consecutive patients after left upper split- lobe resections, to 44 pair-matched controls that received left upper lobectomy for non-small cell lung carcinomas. The control group was matched 1:2 for tumour diameter, histology, nodal status, and patient age. Diagnosis and surgical treatment adhered the principles of tissue-based pre-operative mediastinal staging, sufficient gross surgical margins and intra-operative systematic nodal dissection in both groups.

Results: As intended by study design, the split-lobe and lobectomy group had a similar median tumour diameters of 22,5 (range, 11–63) mm and 25 (range, 7–68) mm respectively, identical histologies (45.5% adenocarcinoma, 4.5% adenocarcinoma in situ, 45.5% squamous cell carcinoma, 4.5% neuroendocrine carcinoma), and identical pN stages (pN0 77.3%, pN1 9.1% , pN2 9.1%, ypN0 4.5%). In the split-lobe group, a lower pre-OP FEV1 (median 2.0 vs. 2.3 l), a higher co-morbidity (median Charlton score 3 vs. 2), and a preponderance of VAT procedures (63.6 vs. 27.3%) were prevalent (all p<0.05). There were no significant outcome differences detected, neither with regard to the post-operative clinical course assessed by intra- and postoperative complications, operation time, tissue margins, duration of drainage and hospital stay, and 30 day mortality, nor with regard to five year overall (0.904 vs. 0.821) and disease-free survival (0.854 vs. 0.609) (all p>0.05).

Conclusion: Left upper lobectomy might be an overtreatment for lung carcinoma resectable by upper trisegmentectomy or resection of the lingula. Tumour diameters exceeding 2 cm, nodal involvement, and previous neoadjuvant treatment do not necessarily exclude this option for selected patients under the condition of a meticulous nodal dissection. The concept of split-lobe resection can possibly be translated to the lower lobes, whose segmental architecture allows a simple surgical division between the apical segment (S6) and the basal segmental group (S7/8-10).