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• W2117547607 abstract "We thank Cao et al. [1] for their insightful comments on our manuscript recently published in the European Journal of CardioThoracic Surgery [2]. Cao et al. addressed, in their letter to the editor, two important and controversial aspects of segmentectomy comparing with lobectomy for early stage non-small-cell lung cancer (NSCLC), which we would like to discuss in detail. The first issue emphasized by Cao et al. was the rationality of using combined overall survival (OS) and cancer-specific survival (CSS) outcomes to compare the two different surgical procedures. Our study aimed at assessing the survival difference between segmentectomy and lobectomy. We must admit that combining OS and CSS does have some shortcomings such as it may overestimate the adverse survival outcomes of segmentectomy procedures just as Cao et al. pointed out. However, the data we based our study on were divergent, with few providing CSS, whereas most of the published studies use OS to assess the two procedures. The overestimation exists in each published study which selected the patients with limited cardiopulmonary function as candidates for segmentectomy; it is inevitable for us to avoid such overestimation. Besides, a previously published paper also used combined OS and CSS to assess oncological outcomes [3]. It is insufficient to conduct meta-analysis for the comparison of segmentectomy and lobectomy exclusively based on either OS or CSS data and it would be possible in future to conduct such a meta-analysis with subgroups of OS and CSS as new suitable data are published. The other issue proposed by Cao et al. is to differentiate the intentional segmentectomy from the compromised one; recently, several studies also excluded compromised segmentectomy and aimed to compare intentional segmentectomy with lobectomy [4, 5]. Some studies, such as Tsutani et al. [6], reported the use of propensity score analysis. We agree with Cao et al. that these studies would be the future direction. However, as the data are insufficient, it is still meaningful to estimate the oncological effects of segmentectomy including both compromised and intentional procedures. We are also undertaking a prospective study aimed at selecting the optimal candidates for intentional segmentectomy. The issue that segmentectomy, especially the intentional one, or lobectomy, which is suitable for early stage NSCLC, would be long-existing until the future randomized controlled trials such as CALGB 140503 and JCOG 0802. We are grateful to Cao et al. [1] for their kind and insightful comments, and we thank them for taking the time to remark on our work." @default.
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• W2117547607 date "2014-04-08" @default.
• W2117547607 modified "2023-09-22" @default.
• W2117547607 title "Reply to Cao et al." @default.
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• W2117547607 doi "https://doi.org/10.1093/ejcts/ezu143" @default.
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