Segmentectomy Versus Wedge Resection for Stage I Non-Small Cell Lung Cancer: A Meta-analysis

Segmentectomy and wedge resection have been recommended as appropriate surgical treatments for patients with poor pulmonary function or major comorbidities. However, for stage I non-small cell lung cancer (NSCLC), it is still undecided whether survival is better with segmentectomy or with wedge resection.

A meta-analysis was performed of studies examining survival outcomes after sublobar resection in patients with stage I NSCLC. Three electronic databases were searched to identify studies that investigated overall survival, cancer-specific survival, and disease-free survival between patients receiving segmentectomy versus wedge resection. A total of 19 relevant studies published before 31 April 2018 that satisfied the inclusion criteria were included in this meta-analysis.

The 19 studies involved a total of 14,197 patients with stage I NSCLC. Overall survival was significantly better after segmentectomy than after wedge resection (hazard ratio [HR] = 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.00001). This was also true of cancer-specific survival (HR = 0.71; 95% CI, 0.64-0.79; P < 0.00001) and disease-free survival (HR = 0.73, 95% CI, 0.54-0.98; P = 0.04). A fixed-model was applied for the analysis as there was no significant heterogeneity between the studies.

Survival after lobar resection for stage I NSCLC is significantly better with segmentectomy than with wedge resection.