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Quality ofLife After Lung Cancer
Surgery
ThomasTsitsias andThanosAthanasiou
13
Introduction
Lung cancer XE " remains one of the commonest
causes of cancer-related death across the world.
Recent advancements in the technical approach of
surgical treatment have contributed to improved
results and prognosis. Health-related quality of life
(HRQOL) has been used more often as a more
advanced measure of outcome than crude mortality
and morbidity. The British Thoracic Society have
suggested that surgery remains the ‘gold standard’
treatment for early stage and locally advanced nonsmall cell lung cancer (NSCLC) [1]. The Get It
Right First Time (GIRFT) report by David Richens
[2] has also recommended that VATS (or minimally
invasive) procedures should be utilised for earlystage lung cancers with a focus on reduced length
of stay and complication rates. The survival benet
of such procedures has been described with high
level of evidence [3–5], however in order to
enhance patients ‘and related clinicians’ (respirology, oncology) condence HRQOL measurements
are essential. Robotic thoracoscopic surgery as
well as ablative radiotherapy are also gaining popularity and prior to adopting them in current practice
their benet on HRQOL should be investigated.
The aim of this study is to provide the readers
with a comprehensive systematic review of all
T. Tsitsias (*) · T. Athanasiou
Department of Cardiothoracic Surgery, Hammersmith
Hospital, Imperial College Healthcare NHS Trust,
London, UK
available literature describing HRQOL outcomes
in patients undergoing an intervention for NSCLC.
Materials andMethods
Search Strategy
This study was performed XE " in accordance
with the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines [6].
A systematic search was carried out through
April 2022 on PudMed using the following terms:
(‘quality of life’) AND (‘lung cancer’ OR ‘thoracic
surgery’ OR ‘lung resection’). References of
selected papers were hand searched to check for
further suitable articles. No papers were excluded
based on patient age or time period of recruitment.
The study selection process is described in Fig.13.1.
Inclusion/Exclusion Criteria
Studies in English XE " reporting HRQOL outcomes in adult patients undergoing any extent of
lung resection (i.e., lobectomy, pneumonectomy,
sublobar) for NSCLC were included as well as
different technical approaches (i.e., open, minimally invasive, stereotactic radiotherapy). Studies
that included patients who underwent chemotherapy or palliative radiotherapy only without any
surgical resection were excluded.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
T. Athanasiou et al. (eds.), Patient Reported Outcomes and Quality of Life in Surgery,
https://doi.org/10.1007/978-3-031-27597-5_13
191
192
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Fig. 13.1 Study
selection process
413 potentially relevant studies were
identified using search strategy
40 full text studies were retrieved for
more detailed evaluation
T. Tsitsias and T. Athanasiou
2 studies excluded
-1 study non-surgical
population
-1 policy report without
HRQOL outcomes
38 studies were included in the
review
Outcomes ofInterest andData
Extraction
Two reviewers XE " (Thomas Tsitsias, Thanos
Athanasiou) identied relevant articles and
reviewed the full text to determine if criteria were
met. Conict between the reviewers was discussed in person until complete agreement was
reached.
The following information was extracted
from each study: Author, year of publication,
period of data collection, research type, study
objective and number of subjects, country, key
patient characteristics, follow-up period for
HRQOL information, specic time points at
which HRQOL was measured, HRQOL instrument used, follow-up completion, key nonHRQOL outcomes and main ndings related to
HRQOL.
Results
Selected Studies
A literature search identied 413 studies, of
which 38 were selected. Data from these studies
are summarized in Table13.1.
Variables found to negatively affect HRQOL
outcomes have been summarized in Fig.13.2.
13 Quality ofLife After Lung Cancer Surgery
Main ndings related to HRQOL
VATS resection patients had a slightly better QOL of
(106.9 SD ± 21.8) compared to (103.7 SD ± 22.3) for
thoracotomy, but this was not signicant (p = 0.799).
There was no statistical difference between the
surgical approach for each of the QOL subscales:
physical (p = 0.444), social (p = 0.455), functional (p
= 0.747) emotional) p = 0.721); and pulmonary (p =
0.741)
HRQOL
instrument used
Follow-up
completeness rate
FACT-L
88%
for RATS but no difference at 2 and 6 months.
The mean SF-36 PCS score was 63.7 ± 22.2 while
mean MCS score was 62.6 ± 24.4, without difference
between the two groups (at 2 or 6 months)
Patients with a higher level of pre-surgery GHS
reported a positive linear trend (B = 0.04; S.E. =
53% at 2 months
38% at 6 months
QLQ-C30
193
(continued)
0.03; p < 0.05), indicating that their GHS increased
more over time, and a negative quadratic rate of
change indicating that their rate of growth
decelerated more over time (B = −0.01; S.E. = 0.01;
p < 0.05).
Lung cancer patients who underwent robot-assisted
or traditional lobectomy and were followed up for
1-year showed the individual change in the 15
dimensions of the EORTC QLQ-C30. Dimensions,
type of surgery, perioperative complications, and age
signicantly affected the post-surgery initial status of
QoL as well as its linear and quadratic trends over
time.
All follow-ups:
55.7%
18.2% missing
data in 1 f/u,
14.8% missing
data in 2 f/u,
114% missing
data in 3 f/u
Follow-up duration
Time points of
HRQOL
measurements
HRQOL
assessment
Country Patient characteristics Pre-op
Study intent and no.
of patients
No 12 months HADS
USA Thoracotomy group:
Thoracotomy vs.
2 months, 12
months
mean age 67.5 ± 9.5
years, 51.5% female,
74.2% underwent
pneumonectomy or
lobectomy
VATS group: mean
age 70.0 ± 10.4
VAT S
97 patients:
Thoracotomy
(n = 66) and VATS (n
= 31)
2 months, 6
months
No 6 months SF -36 At 1-month FEV1, FVC, VC was signicantly better
years, 51.6% female,
54.8% underwent
sublobar resection
mean age 63 ± 11
years, 51% female,
Mean lesion size 30
Belgium Thoracotomy group:
RATS vs.
Thoracotomy
86 patients:
Thoracotomy
Yes 12 months EORTC
(19–42) mm
Thoracotomy group:
mean age 63±
7.68. 39.8% females
All 176 patients
Italy Mean age 66.71 ±
(n = 45) and RATS (n
= 41)
RATS vs.
Thoracotomy
176 patients:
Pre-op, 1 month, 4
months, 8 months,
12 months post op
underwent
pulmonary
lobectomy
Thoracotomy
(n = 117) and RATS
(n = 59)
Author,
publication year,
study period, and
study type
Hopkins etal.
2017
2010–2014
Prospective
Table 13.1 Summary of selected studies reporting HRQOL outcomes
cohort study
Lacroix etal.
2020
2015–2018
Prospective
cohort study
Marzorati etal.
2020
2015–2017
Prospective
cohort study
194
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(RATS vs open): RATS group had lower pain score
and improved QoL at discharge and 12 months after
surgery.
RATS was superior to VATS only in the average
number of LNs dissected. At 12 months, only one
pain score was better for the VATS group with an
Main ndings related to HRQOL
average pain score lower than 1in both groups.
among the thoracotomy group (−2.8; 95% CI: −4.38,
−1.23) while there was a statistically non-signicant
improvement in post-surgical PCS among the VATS
group.
MCS was statistically signicantly improved after
thoracotomy (+1.; 95%CI 0.51, 3.62) but
improvement was not statistically signicant after
VATS.
The method of resection had a signicant impact on
T. Tsitsias and T. Athanasiou
both role function-physical and role function-
emotional subscales from pre- to post-surgery
favouring the VATS approach.
Both groups reported good QOL and high levels of
functioning overall, despite a fairly high incidence of
reported symptoms.
There was a trend for VATS patients to score higher
on the QOL and functioning scales and to report
fewer symptoms.
Only the constipation scale showed signicant
difference (p = 0.001) in favour of patients
undergoing VATS.
HRQOL
instrument used
Follow-up
Follow-up duration
Time points of
HRQOL
HRQOL
assessment
Country Patient characteristics Pre-op
QLQ-C30
completeness rate
measurements
100%
Pre-op, Post
operative Day 3, 2
Yes 12 months EORTC
median age 69 years,
37.9% female,
Median FEV1: 84%
Italy Thoracotomy group:
weeks post op, 6
months, 12
months
(28–154)
VATS group: median
age 70 years, 46.5%
female, Median
FEV1 95% (50–143)
Yes 12 months SF-12 A signicant decrease in PCS score was observed
RATS group: median
age 69 years, 47.2%
female, Median
FEV1 95 (61–139)
Mean age 62.7 ± 8.2
years, 50% female,
USA (2
centres)
100%
Pre-op, 12 months
post op
77% underwent
lobectomy
EORTC
QLQ-C30
100%
Thoracotomy:
39.4 ± 24.1
months
VATS: 33.5 ± 27.7
months
No Mean follow-up
mean age 66.6 ±
13.7 years, 25%
female, 12.5% % has
pN1 disease
VATS group: mean
age 63.0 ± 14.7
China Thoracotomy group:
years, 25.9% female,
3.7% had pN1
disease
Thoracotomy vs.
VATS.RATS
169 patients:
Thoracotomy (n =
58), VATS (n = 58),
2016–2018
Prospective
cohort study
RATS (n = 53)
Thoracotomy vs.
VATS for stage IA
NSCLC
100 patients:
Thoracotomy (n =
85), VATS (n = 15)
Schwartz etal.
2017
2001–2014
Prospective
cohort study
Study intent and no.
of patients
Author,
Table 13.1 (continued)
publication year,
Novellis etal.
2021
study period, and
study type
Thoracotomy vs.
VAT S
51 patients:
Thoracotomy (n =
24), VATS (n = 27)
Li etal. 2002
1994–2000
Prospective
cohort study
13 Quality ofLife After Lung Cancer Surgery
clinically signicantly lower on the dimensions of
breathing (0.637 vs. 0.719, P = .030), speaking
(0.942 vs. 0.973, P = .046), usual activities (0.746 vs.
0.821, P = 0.030), mental function (0.818 vs. 0.917,
P = 0.001), vitality (0.767 vs. 0.824, P = 0.049), and
in the total 15D score (0.809 vs. 0.851, P = .028).
15D The VATS group scored both statistically and
90.5%
Thoracotomy
group 86.3%
VATS group:
94.8%
groups throughout the course of follow-up, whereas
adjusted MCS scores were consistently better in the
thoracotomy group.
No difference was found between groups with
respect to the risk of having clinically signicant
59%
Thoracotomy
group: 55%
VATS group:
pain at each of the outpatient postoperative
evaluations (months 4, 8, and 12)
61%
health dimensions: Bodily pain (BP), Energy,
General Health, Physical Functioning,
100%
group, but QOL with respect to the eight health
dimensions did not differ signicantly between
groups at 3 or 12 months after surgery.
Mental Health, Social Functioning, and role-physical
(RP), but only BP, EG, and RP have statistical
signicance.
Based on data obtained from SF-36 questionnaires,
we can reveal that functional recovery of VATS
lobectomy for lung cancer is superior to OPEN
approaches.
eight health dimensions was decreased in the VATS
group in comparison to that in the thoracotomy
75%
Thoracotomy
At 36 months after surgery, QOL scores for six
group: 59.2%
VATS group:
100%
195
(continued)
health dimensions (PF, SF, RP, RE, BP and GH)
were higher in the VATS group than in the
thoracotomy group and the difference was signicant
for two dimensions (RP and RE).
months
No Minimum of 24
mean age 64.7 ± 8.5
years, 58% female,
mean number of
nodal stations
sampled 4.5
VATS group: mean
Finland Thoracotomy group:
Thoracotomy vs.
VAT S
180 patients:
Thoracotomy (n =
88), VATS (n = 92)
Pre-op, 2 weeks
Yes 12 months SF-36 Adjusted PCS scores were similar between the
age 66.9 ± 8.1 years,
45.7% female, mean
number of nodal
stations sampled 3.5
mean age 66 (22–88)
years, 50% female,
USA Thoracotomy group:
Thoracotomy vs.
VAT S
120 patients:
post op, 4 months,
8 months, 12
months
76%
Adenocarcinoma
VATS group: mean
age 69 (28–85)
years, 64% female,
Thoracotomy (n =
40), VATS (n = 80)
1 month, 6
No 12 months SF-36 VATS group had a higher SF-36 score on seven
89%
Adenocarcinoma
mean age 65 years,
China Thoracotomy group:
Thoracotomy vs.
VATS lobectomy for
months, 12
months post op
42.7% female,
12.7% Pre op
RadioTx
VATS group: mean
age 59 years, 37.7%
stage II NSCLC
127 patients:
Thoracotomy (n =
103), VATS (n = 114)
3 months, 12
months, 36
No 36 months SF-36 At 3 months after surgery, QOL with respect to all
female, 2.3% Pre op
RadioTx
70.2 ± 2.2 years,
37.5% female
Japan Thoracotomy group:
Thoracotomy vs.
VAT S
33 patients:
months post op
VATS group: 63.1 ±
7.9, 58.8% female
Thoracotomy (n =
16), VATS (n = 17)
Rauma etal.
2019
2006–2013
Retrospective
cohort study
Rizk etal. 2014
2009–2012
Zhao etal. 2015
2010–2012
Prospective
cohort study
Aoki etal. 2007
2001–2002
Prospective
cohort study
196
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For the entire follow-up period, quality of life
EORTC QLQ-C30 did not differ signicantly
between groups (p = 0.13).
Emotional function was signicantly better in the
VATS group than in the thoracotomy group during
Main ndings related to HRQOL
the entire follow-up period (p = 0.041)
score was observed 3 weeks postoperatively in the
RATS group compared to patients who underwent an
open rib- and nerve-sparing lobectomy (53.5 vs 40.3;
P < .001, respectively). The 4-month postoperative
mental and physical quality of life scores did not
differ signicantly between the 2 groups.
Global Health status and symptom scale median
scores were similar to the general population and
did not signicantly differ between the two groups.
T. Tsitsias and T. Athanasiou
coughing, SOB and disturbed sleep.
At the 4 weeks follow up U-VATS had lower
proportion of patients with severe fatigue
(p = 0.029), and disturbed sleep (p = 0.029).
The QoL scores were not signicantly different
between two groups at 6-days hospitalization
During the 6-day post operative hospitalization
U-VATS had signicantly lower severe pain
(p = 0.02), fatigue (p = 0.001), constipation,
(p = 0.622) or during the 4 weeks post discharge
(p = 0.168)
HRQOL
instrument used
Follow-up
Follow-up duration
Time points of
HRQOL
HRQOL
assessment
Country Patient characteristics Pre-op
QLQ-C30
72%
completeness rate
measurements
Thoracotomy
2 weeks, 4 weeks,
8 weeks, 12
No 12 months EORTC
mean age 65 (60–72)
years, 53% female,
89% smokers
Denmark Thoracotomy group:
group: 68.6%
VATS group:
74.5%
weeks, 26 weeks,
52 weeks postop
No 4 months SF-12 A signicantly higher average mental quality of life
VATS group: mean
age 66 (62–72)
years, 51% female,
78% smokers
USA RATS group: mean
100%
3 weeks, 4 months
post op
age 66 (31–85)
years, 52% female
QLQ-C30
30%
VATS group:
27.3%
No Median 65 months EORTC
age 65 years, 52%
female, mean
operative time
183min
USA VATS group: mean
RATS group:
36%
RATS group: mean
age68 yeas, 52%
female, mean
operative time
231min
100%
Symptom
Inventory–
Lung Cancer
Pre op, 1 week, 2
Yes 4 weeks MD Anderson
mean age 53.8±9.4
years, 56.9% female,
72.5% had 1 drain
post op
China Uniportal group:
weeks, 3 weeks, 4
weeks
Multiportal group:
55.9±10.0 years,
44.4% female,
63.9% had 2 drains
post op
Thoracotomy vs.
VATS for stage I
NSCLC 201 patients:
Thoracotomy (n =
2016
2008–2014
Randomized
99), VATS (n = 101)
controlled trial
Thoracotomy vs.
RATS (propensity
matched cohort)
106 patients with
RATS resection,
Cerfolio etal.
2011
2010–2011
Retrospective
cohort study
compared with 318
matched thoracotomy
patients
VATS vs. RATS for
NSCLC resection
98 patients: VATS
Worrell etal.
2018
2010–2012
group (n = 73), RATS
group (n = 25)
Retrospective
cohort study
Study intent and no.
of patients
Author,
Table 13.1 (continued)
publication year,
Bendixen etal.
study period, and
study type
Uniportal vs.
Multiportal VATS
lobectomy for
NSCLC
Dai etal. 2021
2017–2020
Retrospective
cohort study
174 patients:
Uniportal (n = 102),
Multiportal (n = 72)
13 Quality ofLife After Lung Cancer Surgery
The functional areas such as physical function, role
function, emotional function and social function and
the overall health status of the uniportal group were
signicantly higher than those of three-portal group
(p < 0.05).
The fatigue and pain scores in the uniportal group
were signicantly lower than those of the three-
portal group (p < 0.05)
In all comparisons, only global health status was
found to be signicantly worse on univariable cox
proportional hazard
modelling for surgical patients when compared to
SABR (HR 0.19, p = 0.038).
Analysis of the SF-HLQ revealed a lower total
productivity cost to society for SABR compared to
surgery. The mean total productivity cost for SABR
was €95 and €3513 for surgery (p = 0.044). Patients
reported a lower total degree of hindrance in paid
and unpaid work for SABR compared to surgery
(mean hindrance scores for SABR: 1.9, for surgery:
6.0, p = 0.010).
VATS patients, who had relatively good functioning
and less symptoms at baseline, reported clinically
signicant deterioration at 6 weeks. In the
subsequent reports at 3, 6 and 12 months the scores
SBRT.All other scores showed signicant
differences between Surgery and SBRT groups at
improved but without regaining baseline levels. The
composite measure of QLQ-C30 Summary score,
showed clinically meaningful deterioration at 6
weeks, with recovery afterwards, without reaching
baseline scores.
Although SABR patients functioning, lung
symptoms (dyspnoea, cough, chest pain) and fatigue
were stable over time, their severity levels remained
worse than those of VATS patients over the 12
months period.
Emotional and cognitive scores showed no
signicant differences between surgery and
baseline.
197
(continued)
After treatment differences were insignicant except
for role functions (16.38) and dyspnoea (8.98).
Average dyspnoea score was also signicantly lower
at 3 months independent of treatment (p = 0.034)
QLQ-C30
95.8%
Pre op, 2 weeks, 4
weeks, 8 weeks
Yes 8 weeks EORTC
mean age 61.3 ±
10.7 years, 45%
female, mean LOS
6.2 days
China Uniportal group:
QLQ-C30
Yes 24 months EORTC
Multiportal group:
mean age 63.5 ± 9.6,
48.3% female, mean
LOS 8.28 days
55% female
Netherlands Mean age 67 years,
100%
Pre op, 3 months,
6 months, 12
months, 18
months, 24
months
QLQ-C30
74%
Surgery group:
77.7%, SABR
group: 68.5%
Pre op, 6 weeks, 3
months, 6 months,
12 months
Yes 12 months EORTC
age 70 ± 8.8 years,
52% female, mean
FEV1 88%
SABR group: mean
age 74.3 ± 9.2 years,
U.K. Surgery group: mean
61% female, mean
FEV1 76.6%
50–75%
QCQ-C30
Pre op, 3 months,
Netherlands Ye s 12 months EORTC
6 months, 12
months
Uniportal vs.
Multiportal VATS
lobectomy for
NSCLC
Xu etal. 2019
2017
Prospective
cohort study
120 patients:
Uniportal (n = 60),
Multiportal (n = 60)
SABR vs. Surgery for
Stage IA NSCLSC
22 patients: SABR (n
= 11), Surgery (n =
11)
Louie etal.
2015
2008–2010
Randomized
controlled trial
VATS vs, SABR for
early-stage NSCLC
134 patients:
VATS (n = 84),
SABR (n = 50)
Pompili etal.
2021
2017–2018
Prospective
cohort study
Surgery vs. SABR for
stage I NSCLC
306 patients: SABR
(265), Surgery (n =
41)
Propensity matched
Alberts etal.
2019
Prospective
cohort study
of 41 patients
198
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Comparing both resections, signicant differences in
evolution of physical functioning (6MPO p = 0.045),
role functioning (3MPO p = 0.035), social
functioning (6MPO p = 0.006, 12MPO p = 0.001)
and general pain (6MPO p = 0.037) were reported in
favour of lobectomy.
The evolution of postoperative coughing is more
favourable after pneumonectomy (1MPO p = 0.049,
Main ndings related to HRQOL
3 MPO p = 0.012, 12 MPO p = 0.022)
signicantly lower PCS (p = 0.04) but similar MCS
(p = 0.2) compared with patients who underwent
lobectomy at 3 months.
No signicant differences of PCS and MCS were
noted between the other groups of patients.
sublobar and lobectomy patients started and
remained below the general population average, both
decreased signicantly in the rst two months after
3 months for the domains of (Physical composite
scale, Role physical, bodily pain).
Patients who underwent pneumonectomy had a
surgery, but signicantly improved by 3 points by the
T. Tsitsias and T. Athanasiou
end of the rst postoperative year.
The average mental health score for both sublobar
and lobectomy patients was above the general
population average prior to surgery, improved by one
point at the end of the rst operative year.
HRQOL
instrument used
Follow-up
Follow-up duration
Time points of
HRQOL
HRQOL
assessment
Country Patient characteristics Pre-op
QCQ-C30
100% at preop
completeness rate
measurements
83% at 1 month,
Pre op, 1 month, 3
months, 6 months,
Yes 12 months EORTC
mean age 73.4 ± 2.8
years, 12% female,
33% stage II/III
Belgium Lobectomy group:
87% at 3
months, 90% at
6 months, 77%
at 12 months
12 months
Pneumonectomy
group: mean age
73.2 ± 3.1 years, 9%
female, 73% stage II/
III
84%
Pre op, 1 month, 3
months
Yes 3 months SF-36 In the ANOVA there was signicant difference after
years, 21% female,
9% neoadjuvant
chemotherapy
Italy Mean age 65.9±10.7
40-60%
Pre op, 4 months,
6 months, 12
months
Yes 12 months SF-12 Overall, the average physical health score for both
mean age 70 years,
65.4% female,
median tumor
diameter 15 (7.5)
mm
Lobectomy group:
mean age 66 years,
67.5% female, mean
USA Sublobar group:
tumor diameter
20(9.7) mm
Lobectomy vs.
Pneumonectomy in
>70 years old patients
with NSCLC
60 patients:
Lobectomy (n = 49),
Pneumonectomy (n =
Study intent and no.
of patients
Author,
Table 13.1 (continued)
publication year,
Balduyck etal.
2009
study type
2003–2006
study period, and
Prospective
11)
cohort study
QOL after major lung
resection (lobectomy/
pneumonectomy) for
NSCLC
156 patients:
Lobectomy (n = 144),
Pneumonectomy (n =
Brunelli etal.
2007
2004–2006
Prospective
cohort study
Sublobar resection
vs. Lobectomy for
12)
Fevrier etal.
2020
Stage IA NSCLC
201 patients:
Sublobar resection (n
= 127), Lobectomy (n
2016
Prospective
cohort study
= 74)
13 Quality ofLife After Lung Cancer Surgery
and the vitality subscale scores were signicantly
lower in the pneumonectomy group compared to the
lobectomy group.
Adjuvant chemotherapy and QoL: In the
multivariable analysis, including age, gender and
type of surgery, adjuvant chemotherapy was
signicantly associated with a decrease in DPCS%,
but not in the DMCS%. In the lobectomy group,
adjuvant chemotherapy resulted in a DPCS% of
26%, compared to 13% in patients without adjuvant
chemotherapy (p = 0.003).
Sleeve lobectomy was characterized by a 1-month
temporary decrease in physical and social
functioning scores after surgery.
Global quality of life, symptom and pain scores
approximated baseline
Lobectomy
group: 87%,
Pneumonectomy
group: 89%
QCQ-C30
100% preop,
90% at 1 month,
80% at 3
preoperative values 1 month after surgery.
For the pneumonectomy group, in the 12 months
follow-up period, there was no return to baseline in
physical and role functioning.
Comparing the two groups signicant differences in
evolution of physical functioning (1MPO p = 0.014,
3MPO p = 0.008, 6MPO p = 0.004), role functioning
(1MPO p = 0.041), cognitive functioning (6MPO p
=0.005, 12MPO p = 0.013) and shoulder dysfunction
(12MPO, p = 0.049) were reported in favour of
sleeve lobectomy.
No striking difference was observed between the two
groups in the scores for overall QOL, pain, fatigue,
appetite, haemoptysis, lung cancer symptoms, or
normal activities.
months, 80% at
6 months, 70%
at 12 months
Lung Cancer
Symptom Scale
(LCSS)
199
(continued)
Comparing bilobectomy to lobectomy, signicant
differences in the evolution of coughing (6 months, p
= 0.012; 3–5 years, p =0.043) and dyspnoea (6
months, p =0.006; 3 years, p = 0.043; 5 years, p =
0.029) were reported in favour of lobectomy.
group: 51.5%
Lobectomy
56.9%
group: 57.7%
Bilobectomy
Pre op, 6 months 84%
Yes 6 months SF-36 Six months after surgery, the physical functioning
mean age 63.8 ± 8.2
years, 54% female,
31% adjuvant
chemotherapy
Pneumonectomy
Sweden Lobectomy group:
Lobectomy vs.
Pneumonectomy via
thoracotomyor major
lung resection
117 patients:
Lobectomy (n = 101),
Yes 12 months EORTC
group: mean age
61.8 ± 7.2 years,
38% female, 81%
adjuvant
chemotherapy
Belgium Sleeve group: mean
Pneumonectomy (n =
16)
Sleeve lobectomy vs.
Pre op, 1 month, 3
months, 6 months,
12 months
age 65.3 ± 7.3 years,
50% female, 70%
stage III
Pneumonectomy
group: 63.3 ± 10.6
years, 50% female,
40% stage III
Pneumonectomy for
NSCLC
30 patients: Sleeve
lobectomy (n = 10),
Pneumonectomy (n =
20)
(mean 3.9 years)
No Up to 7 years
mean age 66.6 ± 9.8
years, 40.6% female,
79.7% stage II/III
Matched Lobectomy
group: mean age
66.3 ± 10.1 years,
USA Bilobectomy group:
Bilobectomy vs.
Lobectomy for
NSCLC resection
Bilobectomy (n =
128), marched cohort
Lobectomy (n = 384)
41.7% female,
77.1% stage II/III
Sartipy etal.
2009
2006–2008
Prospective
cohort study
Balduyck etal.
2008
2003–2005
Prospective
cohort study
Xie etal. 2015
1997–2011
Prospective
cohort study
200
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HRQOL
instrument used
Follow-up
signicant trend over time (P =0.05) and SOBQ (P <
.01) scores, no signicant differences by arm were
observed for any of the scores (P =0.74 for PCS; P =
Main ndings related to HRQOL
completeness rate
0.66 for MCS; P = 0.48 for SOBQ)
At 24 months
SR group:
46.3%, SRB
group: 53.8%
For the entire follow-up period, patients after
segmentectomy showed a fast recovery, documented
from baseline to follow-up at 3 months for physical
functioning and from baseline to follow-up at 6
weeks for global QoL and social functioning.
In the lobectomy group there was a statistically
signicant decrease in physical (p < 0.001) and
cognitive (p = 0.025) functioning from baseline up to
12 months, in social functioning (p < 0.001) and in
At 12 months
follow-up
Lobectomy
group: 81.5%,
Segmentectomy
QCQ-C30
group: 90.6%
T. Tsitsias and T. Athanasiou
scores up to 6 months post- operatively in the
segmentectomy group (p <0.001 and p < 0.001) and
up to 12 months in the lobectomy group (p = 0.003
the global QoL (p < 0.001) up to 6 weeks
post-surgery.
The scores for symptoms scales of fatigue and pain
in general were signicantly higher than the baseline
and p = 0.003).
Follow-up duration
Time points of
HRQOL
measurements
assessment
Yes 24 months SF-36 Comparing the two groups, although PCS showed a
SR group: median
USA
Sublobar resection
HRQOL
Country Patient characteristics Pre-op
Study intent and no.
of patients
Pre op, 3 months,
12 months, 24
months
age 70 years, 56.5%
female, 90.7% ASA
class III/IV
SRB group: median
age 71 years, 54.8%
female, 79.8% ASA
class III/IV
(Multicentre)
(SR) only vs.
Sublobar resection
with brachytherapy
(SRB) for stage I
high-risk NSCLC
patients
212 patients: SR
Pre op, 6 weeks, 3
months, 6 months,
12 months
Yes 12 months EORTC
Lobectomy group:
median age 66 years,
44.4% female,
42.6% VATS
approach
Multicentre
(Germany,
Austria,
Switzerland)
group (n = 108), SRB
group (n = 104)
Lobectomy vs.
Segementectomy for
early (<2 cm)
NSCLC
107 patients:
Segmentectomy
group: median age
69 years, 39.6%
female, 22.6% VATS
approach
Lobectomy (n = 54),
Segmentectomy (n =
53)
Fernando etal.
2015
2005–2013
Randomized
Author,
Table 13.1 (continued)
publication year,
study period, and
study type
controlled trial
Stamatis etal.
2019
2013–2016
Randomized
controlled trial
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