title: Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients?
abstract: OBJECTIVE
  The aim of this study was to evaluate whether sublobar resection could achieve recurrence and survival rates equivalent to lobectomy in high-risk elderly patients.
  
  
  METHODS
  We conducted a retrospective multicenter study that including all consecutive patients (aged >75 years) who underwent operation for clinical stage I non-small cell lung cancer (NSCLC). The clinicopathological data, postoperative morbidity and mortality, recurrence rate and vital status were retrieved. The overall survival, cancer-specific survival and disease-free survival were also assessed.
  
  
  RESULTS
  Two hundred and thirty-nine patients (median age 78 years) were enrolled. Lobectomies were performed in 149 (62.3 %) patients and sublobar resections in 90 (39 segmentectomies, 51 wedge resections). There were no differences in the recurrence rates following lobar versus sublobar resections (19 versus 23 %, respectively; p = 0.5) or the overall survival (p = 0.1), cancer-specific survival (p = 0.3) or disease-free survival (p = 0.1). After adjusting for 1:1 propensity score matching and a matched pair analysis, the results remained unchanged. A tumor size >2 cm and pN2 disease were independent negative prognostic factors in unmatched (p = 0.01 and p = 0.0003, respectively) and matched (p = 0.02 and p = 0.005, respectively) analyses.
  
  
  CONCLUSIONS
  High-risk elderly patients may benefit from sublobar resection, which provides an equivalent long-term survival compared to lobectomy.
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy. alfonso.fiorelli@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Caronia
authors.affiliation: Thoracic Surgery Unit, University of Bologna, Bologna, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Daddi
authors.affiliation: Thoracic Surgery Unit, University of Foggia, Foggia, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Loizzi
authors.affiliation: Thoracic Surgery Unit, University of Parma, Parma, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ampollini
authors.affiliation: Thoracic Surgery Unit, University of Foggia, Foggia, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ardò
authors.affiliation: Thoracic Surgery Unit, University of Parma, Parma, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ventura
authors.affiliation: Thoracic Surgery Unit, University of Parma, Parma, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carbognani
authors.affiliation: Thoracic Surgery Unit, University of Perugia, Perugia, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Potenza
authors.affiliation: Thoracic Surgery Unit, San Luigi Hospital, University of Turin, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardissone
authors.affiliation: Thoracic Surgery Unit, University of Foggia, Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sollitto
authors.affiliation: Thoracic Surgery Unit, University of Bologna, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mattioli
authors.affiliation: Thoracic Surgery Unit, University of Perugia, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Puma
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
authors.affiliation: Thoracic Surgery Unit, University of Terni, Terni, Italy.
authors.forename: Mark
authors.initials: M
authors.lastname: Ragusa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Elderly; Lobectomy; Non-small cell lung cancer; Sublobar resection; Surgery