Segmentectomy for non-peripheral and peripheral small-sized non-small-cell lung cancer

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonology

Background:

• Segmentectomy is a lung-sparing surgical option for early-stage non-small-cell lung cancer (NSCLC).
• Tumor location (peripheral vs. non-peripheral) may influence oncological outcomes after segmentectomy.
• Understanding these differences is crucial for optimizing treatment strategies.

Purpose of the Study:

• To compare oncological outcomes between segmentectomy for non-peripheral and peripheral small-sized NSCLC.
• To identify factors influencing disease-free survival (DFS) and overall survival in these patient groups.

Main Methods:

• Retrospective observational study of 850 patients with clinical stage IA1-A2 NSCLC undergoing segmentectomy.
• Patients classified into non-peripheral (tumor distance index ≤ 2/3) and peripheral (tumor distance index > 2/3) groups.
• Comparison of 5-year DFS and overall survival using log-rank tests; multivariable and subgroup analyses performed.

Main Results:

• No significant difference in 5-year DFS (92.2% vs. 91.2%) or overall survival (96.3% vs. 93.6%) between non-peripheral and peripheral groups overall.
• Higher margin recurrence rates observed in the non-peripheral group.
• Subgroup analysis revealed significantly worse 5-year DFS (62.1% vs. 76.3%) and higher margin recurrence (13.2% vs. 2.0%) in non-peripheral *solid* NSCLC.

Conclusions:

• Segmentectomy provides comparable overall survival for small-sized non-peripheral and peripheral NSCLC.
• Non-peripheral solid NSCLC demonstrates inferior DFS and increased margin recurrence after segmentectomy.
• Tumor characteristics, particularly the solid subtype in non-peripheral locations, require careful consideration for segmentectomy outcomes.