Hüseyin MELEK, Tolga Evrim SEVİNÇ, Deniz SIĞIRLI, Ahmet Sami BAYRAM, Cengiz GEBİTEKİN

Sol Üst Lob Evre I Akciğer Kanserli Hastalar İçin Sol Üst Lobektomi Aşırı Tedavi mi? Propensity Skor Analizi

Sol üst lobda yer alan küçük hücreli dışı akciğer kanseri (KHDAK) için sol üst lobektomi ve segmentektomi sonuçlarını karşılaştırmayı amaçladık. Kliniğimizde 1999-2016 yılları arasında sol üst lob yerleşimli KHDAK nedeniyle segmentektomi veya lobektomi uygulanan hastaların verilerini retrospektif olarak inceledik. Segmentektomi; lobektomi için uygun evre I hastalar ve sınırlı kardiyopulmoner rezervi nedeniyle lobektomi için uygun olmayan hastalarda uygulandı. Toplamda 127 hasta optimal veri eşleştirme algoritması kullanılarak propensity skoru analizine dahil edildi. 1: 2 eşleştirme algoritmasından sonra 90 hasta iki gruba ayrıldı; grup 1 segmentektomi (n=30) ve grup 2 lobektomi (n=60). Morbidite, mortalite, uzun dönem sağkalım oranları ve prognostik faktörler analiz edildi. Histopatolojik incelemede 57 hasta evre I [grup 1 (n = 18), grup 2 (n = 39)], 33 hasta evre II-IV [grup 1 (n = 12), grup 2 (n = 21 )] tespit edildi. Morbidite oranı % 37.78 (37/90) [grup 1: n = 11 (% 36.67), grup 2: n = 23 (% 38.33), p = 1.000] ve mortalite oranı % 1.11 [grup 1: n = 1 (% 3.33), grup 2: n = 0 (% 0), p = 0.333] idi. Evre I hastalarda ortalama Kaplan-Meier sağkalım süresi grup 1 için 146.09 (% 95 CI: 111.70-180.49) ve grup 2 için 106.99 (% 95 CI: 77.68-136.30) idi (p = 0.185) olarak sonuçlandı. Bu çalışmada sol üst lobda segmentektomi veya lobektomi uygulanan erken evre KHDAK'li hastalar için benzer sonuçlar elde edildi. Özellikle lingulektomi veya trisegmentektomi, evre I KHDAK için lobektomiye kıyasla standart bir prosedür olarak önerilmektedir.

Anahtar Kelimeler:

trisegmentektomi, lingulektomi, sol üst lobektomi, akciğer rezeksiyonu

Is Left Upper Lobectomy an Overtreatment for Patients with Stage I Lung Cancer in the Left Upper Lobe? A Propensity Score-Matched Analysis.

We aim to compare the outcomes of left upper lobectomy and segmentectomy for non-small cell lung cancer (NSCLC) located at the left upper lobe. We retrospectively reviewed the medical data of patients with NSCLC located in the left upper lobe who underwent segmentectomy or lobectomy between 1999 and 2016. Segmentectomy was preferred for patients with stage I who were also eligible for lobectomy and for patients who were not eligible for lobectomy due to limited cardiopulmonary reserve. In total, 127 patients were included into the propensity score analysis by using optimal data matching algorithm. After the 1:2 matching algorithm, 90 patients were divided into two groups; group 1 segmentectomy (n=30), and group 2 lobectomy (n=60). The morbidity, mortality, long-term survival rates and prognostic factors were analyzed. Histopathological investigation revealed 57 patients as stage I [group 1 (n=18), group 2 (n= 39)], 33 patients as stage II-IV [group 1 (n=12), group 2 (n= 21)]. Morbidity rate was 37.78% (37/90) [group 1: n=11 (36.67%), group 2: n=23 (38.33%), p=1.000] along with mortality rate of 1.11% [group 1: n=1 (3.33%), group 2: n=0 (0%), p=0.333]. In stage I patients, mean Kaplan-Meier survival time was 146.09 (95%CI: 111.70-180.49) for group I and 106.99 (95%CI: 77.68-136.30) for group 2 (p=0.185). This study revealed similar outcomes for patients with early stage NSCLC located at the left upper lobe undergoing either segmentectomy or lobectomy. In particular, lingulectomy or trisegmentectomy is recommended as a standard procedure for Stage I NSCLC compared to lobectomy.

Keywords:

trisegmentectomy, lingulectomy, left upper lobectomy, lung resection,

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