Operative Strategy in NSCLC: A Meta-Analysis of 16,943 Patients

Objectives: The objective of this systematic literature review with meta-analysis was to determine whether a lobectomy is superior to either sublobar or wedge resection in NSCLC.

Methods: Randomized controlled and observational trials were searched in Medline and the Cochrane Database. The literature research was conducted on August 1^st 2016. All articles published since January 1950 were included into the analysis. The common statistics for meta-analysis such as I²-test and Q-statistics to analyze the heterogeneity of the data, the Matel-Haenszel-test or the DerSimonian-Laird-test, depending on the heterogeneity, to evaluate significance and the Egger-regression to reveal a possible bias were applied. 3-, 5-, and 10-year survival were investigated. Furthermore 5-year disease-free-survival was assessed.

Results: Out of a total of 1,646 articles 48 studies with a total of 16,934 patients were entered into the meta-analysis. All studies included subgroups of lobectomy, sublobar or wedge resection. 42 studies with a total of 15,505 patients reported a 5-year survival rate. The 5-year disease-free survival was reported in 13 studies including 4,881 patients. The patient’s mean age was 69.8 ± 6.6 years; 57.2 ± 1.6% of them were male. The patient characteristics did not significantly differ over the three different surgical groups (p > 0.05) .Subgroup analysis regarding the survival after 3-years showed no significant difference between lobectomy, segmentectomy or wedge resection (p = 0.85).The 5-year survival for patients after lobectomy was significantly better in comparison to segmentectomy (OR: 0.72; 95%-CI: 0.57 - 0.92; p = 0.0075). Lobectomy was also significantly superior to wedge-resection regarding 5-year survival rate (OR: 0.52; 95%-CI: 0.34–0.79; p = 0.0025). A combined group of segmental and wedge resection was also significantly inferior to lobectomy. (OR: 0.62; 95%-CI: 0.46–0.83; p = 0.0014)The 5-year disease-free-survival was significantly better after lobectomy compared with segment or wedge resection. (OR: 0.59; 95%-CI: 0.42–0.83; p = 0.0028).

Conclusion: In this meta-analysis we were able to show that lobectomy is the best surgical option for NSCLC patients that undergo curative treatment. Due to limited data availability in most endpoints, it is not possible to evaluate whether a segmentectomy or wedge resection might be a justified in patients with stage I disease.