Is Lobectomy Actually Worse Than Segmentectomy for All Stage I Non-Small Cell Lung Cancer?

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Recent studies suggest segmentectomy as a viable alternative to lobectomy for peripheral, node-negative non-small cell lung cancer (NSCLC) under 2 cm.
• This study retrospectively analyzed a large dataset to evaluate this hypothesis in stage I NSCLC patients.

Purpose of the Study:

• To compare the efficacy of segmentectomy versus lobectomy in patients with stage I non-small cell lung cancer (NSCLC).
• To assess overall survival, lung cancer-specific survival, and short-term mortality following these surgical procedures.

Main Methods:

• Retrospective analysis of stage I NSCLC patients (≤4 cm) who underwent either segmentectomy or lobectomy between 2000 and 2017.
• Propensity score matching (1:1 ratio) was used to balance baseline characteristics between the two surgical groups.
• Primary endpoints included overall and lung cancer-specific survival; secondary endpoints were 30-day and 90-day mortality.

Main Results:

• After propensity score matching, 2016 patients in each group (segmentectomy vs. lobectomy) were analyzed.
• No significant difference was observed in overall survival (HR: 0.87) or lung cancer-specific survival (HR: 0.81) between segmentectomy and lobectomy for stage IA NSCLC (≤3 cm).
• Lobectomy was associated with higher 30-day mortality (2.1% vs. 1.1%, P=0.01), but no significant difference in 90-day mortality was found.

Conclusions:

• Segmentectomy is a suitable alternative to lobectomy for stage IA non-small cell lung cancer (NSCLC) regarding long-term survival.
• Lobectomy may be associated with poorer early postoperative recovery compared to segmentectomy in NSCLC patients.