Commentary: sublobar versus lobar resection: further added favourable outcomes in addition to survival

Kamigaichi et al. report an interesting article titled ‘Segmentectomy preserves better immune-nutritional status than lobectomy in patients with early-stage lung cancer’ in which they evaluated postoperative immune status in patients who underwent segmentectomy versus lobectomy. The authors performed a retrospective study and identified 210 patients who underwent segmentectomy and 164 who underwent a lobectomy then they matched 126 pairs. They reported that the nutritional status in patients who underwent segmentectomy was superior to those who underwent lobectomy in terms of higher prognostic nutritional index (PNI) and albumin level at 1 month, 2 years and 3 years postoperatively [1].

Prior series established an association between nutritional status preoperatively and oncological outcomes in non-small-cell lung cancer (NSCLC) [2]. In many studies, segmentectomies have been shown to preserve lung function with similar survival patterns as lobectomies in early-stage NSCLC. In the 2 recently published randomized clinical trials, the oncological outcomes showed similar outcomes in sublobar resection versus lobar resection; the Japanese Clinical Oncology Group 0802 (JCOG0802) and Cancer and Leukemia Group B 140503 (CALGB 140503). JCOG0802 compared segmentectomy versus lobectomy and showed that 5-year overall survival of the segmentectomy group was superior to lobectomy [3]. In addition, CALGB 140503 demonstrated that sublobar resection was noninferior to lobar resection in terms of overall survival and disease-free survival [4].

Furthermore, retrospective studies of large databases have also shown equivalent oncological outcomes for segmentectomies compared to lobectomies in early-stage NSCLC. Kamel et al. [5] queered a single institutional database for patients with cT1N0 with hypermetabolic nodules on PET scan who underwent segmentectomy versus lobectomy that showed comparable oncological outcomes of these 2 groups, even though patients that underwent lobectomies had higher lymph nodes removed and higher pathological upstaging with no effect on cancer-specific survival or recurrence-free survival. In addition, Mynard et al. [6] queered the national cancer database to identify patients with small early-stage NSCLC with occult nodal disease and found that survival outcomes were similar regardless of the presence of occult nodal disease.

In these patients who underwent segmentectomies, the preservation of lung function translated into better preservation of immune-nutritional status compared to the patients who underwent lobectomy [1]. It is known that the immune system plays a crucial role in the body’s ability to recover after surgery and that chronic inflammation that is associated with cancer alters the immune system [5]. Nutritional status has also been linked to improved outcomes and malnutrition has been associated with extended resections and has been shown to increase morbidity and mortality through different mechanisms [7]. The resection of large portion of the lung may make a patient more susceptible to infection and other complications and more likely to result in malnutrition. As stated by Kamigaichi et al. [1], patients who underwent segmentectomy were significantly less likely to develop malnutrition as compared to lobectomies.

REFERENCES