Tsutani Y, et al. - In elderly patients with non-small-cell lung cancer, researchers investigated the outcomes of sublobar resection. Compared to lobectomy, sublobar resection was associated with less severe postoperative complications and similar overall survival and could be considered as an optimal procedure in elderly patients with clinical Stage I non-small-cell lung cancer.

Methods

• Complete surgical resection for clinical Stage I non-small-cell lung cancer was performed on 794 consecutive patients.
• From these patients, a total of 205 patients aged ≥75 years were identified.
• Comparison of the outcomes of lobectomy and sublobar resection was performed.
• They estimated propensity scores for multivariable analyses and matching.

Results

• In older patients (P=0.027) and those with lower maximum standardized uptake on positron emission tomography (P < 0.001), lower T stage (P < 0.001), lower %vital capacity (P=0.007) and lower %diffusing capacity of the lungs for carbon monoxide (P=0.025), sublobar resection (n = 99) was more frequently performed compared to lobectomy (n = 106).
• More frequent severe (≥Grade IIIa) postoperative complications occurred with lobectomy (11 of 106 procedures, 10.4%) than with sublobar resection (5 of 99, 5.1%; P=0.16).
• Lobectomy was an independent predictive factor for severe postoperative complications (odds ratio 3.49, 95% confidence interval 1.01–12.05; P=0.048), as per the propensity score-adjusted multivariable analysis.
• No significant difference regarding overall survival (OS) was evident following lobectomy (5-year OS 67.2%) or sublobar resection (5-year OS 73.9%; P=0.93).
• Multivariable analysis suggested that the surgical procedure was not an independent predictive factor for OS (lobectomy: hazard ratio 1.03, 95% confidence interval 0.49–2.16; P=0.94).