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J Chest Surg

Published online June 5, 2024

Copyright © Journal of Chest Surgery.

Potential Survival Benefit of Upfront Surgery for Lung Tumors Unconfirmed but Highly Suspicious for Stage I Lung Cancer

Murat Kara , M.D.1, Eren Erdogdu , M.D.1, Salih Duman , M.D.1, Gulnar Fatalizade , M.D.1, Berker Ozkan , M.D.1, Alper Toker , M.D.2

1Department of Thoracic Surgery, Istanbul University Medical Faculty, Istanbul, Turkey; 2Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA

Correspondence to:Eren Erdogdu
Tel 90-5057170960
Fax 90-2124142500
E-mail eren.erdogdu@istanbul.edu.tr
ORCID
https://orcid.org/0000-0001-8153-0107

Received: November 29, 2023; Revised: February 16, 2024; Accepted: February 26, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Patients with early-stage lung tumors that are highly suspicious for malignancy typically undergo a preoperative diagnostic workup, primarily through bronchoscopy or transthoracic biopsy. Those without a preoperative diagnosis may alternatively be treated with upfront surgery, contingent upon the potential for intraoperative diagnosis. Previous studies have yielded conflicting results regarding the impact of upfront surgery on the survival of these patients. Our study aimed to elucidate the effect of upfront surgery on the survival outcomes of patients undergoing surgery for early-stage lung cancer without a preoperative diagnosis.
Methods: We analyzed the survival rate of 158 consecutive patients who underwent pulmonary resection for stage I lung cancer, either with or without a preoperative diagnosis.
Results: A total of 86 patients (54%) underwent upfront surgery. This approach positively impacted both disease-free survival (p=0.031) and overall survival (p=0.017). However, no significant differences were observed across subgroups based on sex, smoking status, forced expiratory volume in 1 second, histologic tumor size, or histologic subtype. Univariate analysis identified upfront surgery (p=0.020), age (p=0.002), maximum standardized uptake value (SUVmax) exceeding 7 (p=0.001), and histological tumor size greater than 20 mm (p=0.009) as independent predictors. However, multivariate analysis indicated that only SUVmax greater than 7 (p=0.011) was a significant predictor of unfavorable survival.
Conclusion: Upfront surgery does not appear to confer a survival advantage in patients with stage I lung cancer undergoing surgical intervention.

Keywords: Lung carcinoma, Diagnosis, Video-assisted thoracoscopic surgery, Surgery

Article

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J Chest Surg

Published online June 5, 2024

Copyright © Journal of Chest Surgery.

Potential Survival Benefit of Upfront Surgery for Lung Tumors Unconfirmed but Highly Suspicious for Stage I Lung Cancer

Murat Kara , M.D.1, Eren Erdogdu , M.D.1, Salih Duman , M.D.1, Gulnar Fatalizade , M.D.1, Berker Ozkan , M.D.1, Alper Toker , M.D.2

1Department of Thoracic Surgery, Istanbul University Medical Faculty, Istanbul, Turkey; 2Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA

Correspondence to:Eren Erdogdu
Tel 90-5057170960
Fax 90-2124142500
E-mail eren.erdogdu@istanbul.edu.tr
ORCID
https://orcid.org/0000-0001-8153-0107

Received: November 29, 2023; Revised: February 16, 2024; Accepted: February 26, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Patients with early-stage lung tumors that are highly suspicious for malignancy typically undergo a preoperative diagnostic workup, primarily through bronchoscopy or transthoracic biopsy. Those without a preoperative diagnosis may alternatively be treated with upfront surgery, contingent upon the potential for intraoperative diagnosis. Previous studies have yielded conflicting results regarding the impact of upfront surgery on the survival of these patients. Our study aimed to elucidate the effect of upfront surgery on the survival outcomes of patients undergoing surgery for early-stage lung cancer without a preoperative diagnosis.
Methods: We analyzed the survival rate of 158 consecutive patients who underwent pulmonary resection for stage I lung cancer, either with or without a preoperative diagnosis.
Results: A total of 86 patients (54%) underwent upfront surgery. This approach positively impacted both disease-free survival (p=0.031) and overall survival (p=0.017). However, no significant differences were observed across subgroups based on sex, smoking status, forced expiratory volume in 1 second, histologic tumor size, or histologic subtype. Univariate analysis identified upfront surgery (p=0.020), age (p=0.002), maximum standardized uptake value (SUVmax) exceeding 7 (p=0.001), and histological tumor size greater than 20 mm (p=0.009) as independent predictors. However, multivariate analysis indicated that only SUVmax greater than 7 (p=0.011) was a significant predictor of unfavorable survival.
Conclusion: Upfront surgery does not appear to confer a survival advantage in patients with stage I lung cancer undergoing surgical intervention.

Keywords: Lung carcinoma, Diagnosis, Video-assisted thoracoscopic surgery, Surgery

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