A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors.

Autor:	Bade BC; Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA., Blasberg JD; Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA., Mase VJ Jr; Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA., Kumbasar U; Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey., Li AX; Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA., Park HS; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA., Decker RH; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA., Madoff DC; Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA., Brandt WS; Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA., Woodard GA; Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA., Detterbeck FC; Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2022 Jun; Vol. 14 (6), pp. 2387-2411.
DOI:	10.21037/jtd-21-1825
Abstrakt:	Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results: In older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn't been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined. Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors <1 cm are not a reliably favorable group. Conclusions: A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making. Competing Interests: Conflicts of interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-1825/coif). The series “A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation” was commissioned by the editorial office without any funding or sponsorship. FCD served as the unpaid Guest Editor of the series. HSP serves as an unpaid editorial board member of Journal of Thoracic Disease. BCB reports in the past 36 months, he receives grants from Veterans Affairs Central Office, American Cancer Society, Yale SPORE in Lung Cancer. HSP reports research funding from RefleXion Medical; consulting fees from AstraZeneca; honoraria and speaking fees from Bristol Myers Squibb; and advisory board fees from Galera Therapeutics; all unrelated to current work. The authors have no other conflicts of interest to declare. (2022 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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