부산대학교 도서관

Segmentectomy is a standard surgical treatment option for stage IA non-small cell lung cancer (NSCLC). However, segmentectomy is only an oncologically safe and reasonable alternative to lobectomy when the intraoperative lymph node staging and surgical margin are adequate. The aim of the present study was to compare the outcomes (frequency, reasons, and prognosis) of patients converted from segmentectomy to lobectomy at the intraoperative direction of the surgical team. This retrospective study analyzed the outcomes of 121 patients who were scheduled to undergo segmentectomy for clinical stage IA NSCLC between January 2014 and August 2020. Eight of the 121 patients were converted from segmentectomy to lobectomy based on the intraoperative diagnosis and surgeon's judgment. Among the 8 converted cases, 4 were diagnosed with lymph nodes metastasis based on analysis of frozen sections and 4 had a problem related to the surgical technique (e.g., surgical margin or uncontrollable bleeding). Diagnosis of the 3 node malignant-positive patients was guided by rapid-immunohistochemistry using noncontact alternating current electric field mixing. There was no significant difference in overall survival between patients with completed segmentectomy (n=113) and those converted to lobectomy (n=8) (P=0.5828). In clinical stage IA NSCLC patients, lobectomy can be selected instead of segmentectomy, if appropriate judgement/diagnosis is intraoperatively achieved.