Segmentectomy vs Lobectomy for Early Non-Small Cell Lung Cancer With Visceral Pleural Invasion

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Segmentectomy and lobectomy are surgical options for early non-small cell lung cancer (NSCLC).
• Visceral pleural invasion (VPI) in NSCLC indicates aggressive disease and poorer prognosis.
• The efficacy of segmentectomy for NSCLC with VPI is not well-established.

Purpose of the Study:

• To compare the overall survival and short-term outcomes of segmentectomy versus lobectomy in patients with early-stage NSCLC and VPI.
• To determine if segmentectomy is a sufficient surgical approach for NSCLC tumors with VPI.

Main Methods:

• Analysis of patients with cT1a-bN0M0 NSCLC and VPI from the National Cancer Database (2010-2020).
• Inclusion of only patients without comorbidities to minimize selection bias.
• Comparison of overall survival using multivariable-adjusted Cox proportional hazards and propensity score-matched analyses.

Main Results:

• No significant difference in 5-year overall survival between segmentectomy and lobectomy groups (adjusted hazard ratio, 0.91).
• Similar rates of surgical margin positivity, 30-day readmission, and 30-/90-day mortality for both surgical approaches.
• Segmentectomy was performed in 7% of the cohort, while lobectomy was performed in 93%.

Conclusions:

• Segmentectomy and lobectomy yield comparable survival and short-term outcomes for early-stage NSCLC with VPI.
• Completion lobectomy after segmentectomy for NSCLC with VPI is unlikely to provide additional survival benefit.
• Segmentectomy may be a sufficient surgical option for select early-stage NSCLC patients with VPI.