Left Upper Lobe Multi-Segmentectomy Versus Lobectomy for Early-Stage Lung Cancer: A Meta-Analysis

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Left upper lobe (LUL) multi-segmentectomy involves complex hilar anatomy, potentially impacting outcomes differently than single segmentectomy or lobectomy for early-stage lung cancer.
• No prior meta-analyses have compared LUL multi-segmentectomy with LUL lobectomy for early-stage lung cancer management.
• This study aimed to evaluate LUL multi-segmentectomy's non-inferiority in long-term survival and superiority in in-hospital outcomes compared to LUL lobectomy.

Approach:

• A meta-analysis was conducted using studies from PubMed, Embase, and Cochrane Library.
• Studies compared LUL multi-segmentectomy versus LUL lobectomy in early-stage lung cancer (T2 N0 or less).
• Kaplan-Meier curves assessed overall and disease-free survival; random effects models analyzed complications, length of stay, and recurrence.

Key Points:

• Five studies with 1,196 patients were analyzed.
• Five-year overall survival was comparable (92.6% multi-segmentectomy vs. 89.3% lobectomy, P=0.188).
• LUL multi-segmentectomy demonstrated superior 5-year disease-free survival (93.1% vs. 88.4%, P=0.041) and reduced hospital stay (-0.26 days, P<0.01).

Conclusions:

• LUL multi-segmentectomy is a viable alternative to LUL lobectomy for early-stage lung cancer, offering comparable long-term overall survival.
• The procedure is associated with significantly shorter hospital lengths of stay.
• No significant differences were observed in in-hospital complications or recurrence rates between the two surgical approaches.