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Equivalent Survival Between Lobectomy and Segmentectomy for Clinical Stage IA Lung Cancer
Mark W Onaitis1, Anthony P Furnary2, Andrzej S Kosinski3
1Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California.
The Annals of Thoracic Surgery
|March 3, 2020
Summary
Segmentectomy and lobectomy offer similar long-term survival for early-stage lung cancer patients. This suggests surgeons appropriately select patients for sublobar lung cancer resections.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- The oncologic efficacy of segmentectomy versus lobectomy for early-stage lung cancer remains debated.
- Clinical stage IA (T1N0) lung cancer patients are candidates for both surgical approaches.
Purpose of the Study:
- To compare the long-term survival outcomes of segmentectomy and lobectomy in clinical stage IA lung cancer patients.
- To evaluate surgeon appropriateness in selecting patients for sublobar resections.
Main Methods:
- Utilized The Society of Thoracic Surgeons General Thoracic Surgery Database linked with Medicare data (2002-2015).
- Included 14,286 clinical stage IA lung cancer patients (1654 segmentectomy, 12,632 lobectomy).
- Employed Cox regression and propensity score matching to analyze long-term survival.
Main Results:
- Segmentectomy demonstrated survival similar to lobectomy in Cox modeling (HR 1.04) and matched cohorts.
- Subanalysis of 2009-2015 data (accurate staging) confirmed similar survival (HR 1.00).
- Pathologic N0 subgroup also showed comparable survival outcomes between the two procedures.
Conclusions:
- Lobectomy and segmentectomy are equally effective treatments for early-stage lung cancer, yielding similar survival rates.
- Surgeons appear to be appropriately selecting patients for segmentectomy based on outcomes in this large database study.
