Surgical Procedure Selection for Stage I Lung Cancer: Complex Segmentectomy versus Wedge Resection

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Sublobar resection is common for lung cancer, but outcomes of complex segmentectomy versus wedge resection are understudied.
• Key comparisons regarding mortality, morbidity, surgical margins, lymph node dissection, and survival are lacking.
• This study addresses the need for comparative data on these two sublobar resection techniques.

Purpose of the Study:

• To compare operative and postoperative outcomes between complex segmentectomy and wedge resection for clinical stage I lung cancer.
• To evaluate differences in mortality, morbidity, surgical margins, lymph node dissection, and long-term survival.
• To provide evidence-based insights into the optimal surgical approach for early-stage lung cancer.

Main Methods:

• Retrospective review of 216 patients with clinical stage I lung cancer undergoing complex segmentectomy (n=110) or wedge resection (n=106).
• Propensity score matching created 61 pairs for balanced comparison of operative and postoperative results.
• Kaplan-Meier method assessed factors influencing survival outcomes.

Main Results:

• Complex segmentectomy showed improved median surgical margin distance (15.0 vs. 10.0 mm) and significantly more lymph nodes dissected (6.0 vs. 0.0 nodes).
• While overall complications and prolonged air leakage were numerically higher in segmentectomy, major complications and 30-day mortality were comparable.
• Complex segmentectomy demonstrated superior 5-year overall survival (94.7% vs. 79.4%) and recurrence-free survival (94.0% vs. 76.5%).

Conclusions:

• Complex segmentectomy provides superior oncological and survival outcomes compared to wedge resection for clinical stage I lung cancer.
• Perioperative safety is acceptable and comparable between complex segmentectomy and wedge resection.
• Complex segmentectomy is a favorable surgical option for selected early-stage lung cancer patients.