Propensity-matched Comparison of VATS Left Upper Trisegmentectomy and Lobectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for lung cancer resection.
• Left upper trisegmentectomy (LTS) and left upper lobectomy (LUL) are surgical options for stage I non-small cell lung cancer (NSCLC).
• Comparative oncologic outcomes between VATS LTS and LUL require further investigation.

Purpose of the Study:

• To compare the oncologic outcomes of VATS left upper trisegmentectomy (LTS) versus left upper lobectomy (LUL) in patients with stage I non-small cell lung cancer (NSCLC).

Main Methods:

• Retrospective analysis of 1543 patients undergoing VATS LTS or LUL for stage I NSCLC from 2013-2017.
• Propensity-score matching was used to create 273 comparable pairs of patients.
• Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and log-rank tests.

Main Results:

• No significant differences in operative duration, blood loss, or complications were observed between LTS and LUL groups.
• LUL resulted in longer postoperative hospital stays, greater tumor margin distance, and more lymph nodes harvested compared to LTS.
• Median DFS and OS were comparable between the LTS and LUL groups, with similar outcomes across subgroups.

Conclusions:

• VATS LTS and LUL demonstrate comparable oncologic outcomes for stage I NSCLC.
• The choice between LTS and LUL can be based on achieving negative margins, irrespective of tumor pathology or radiologic findings.
• Both VATS procedures are effective options for early-stage NSCLC management.