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Recurrence Pattern of Left Upper Lobectomies and Trisegmentectomies: Systematic Review and Meta-Analysis.

Borja Aguinagalde1,2,3, Juan A Ferrer-Bonsoms4, Iker López1,3

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Left upper lobectomy and trisegmentectomy for early-stage non-small-cell lung cancer show similar locoregional recurrence. Trisegmentectomy, however, had lower distant recurrence and shorter hospital stays.

Keywords:
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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Pulmonary Medicine

Background:

  • Surgical resection is the standard for early-stage non-small-cell lung cancer (NSCLC).
  • Lobectomy is traditional, but trisegmentectomy is emerging as a comparable alternative.
  • This study compares left upper lobe trisegmentectomy to lobectomy for NSCLC.

Purpose of the Study:

  • To evaluate if left upper lobe trisegmentectomy offers non-inferior or superior oncologic outcomes compared to lobectomy.
  • To specifically analyze recurrence patterns (locoregional and distant) between the two surgical approaches.
  • To assess perioperative outcomes, including morbidity and hospital stay.

Main Methods:

  • A systematic review and meta-analysis adhering to PRISMA guidelines.
  • Inclusion of comparative studies contrasting left upper lobectomy and trisegmentectomy.
  • Statistical analysis using the R meta package's metabin function to assess recurrence, morbidity, and hospital stay.

Main Results:

  • Nine of 14 identified articles met inclusion criteria.
  • No significant difference in locoregional recurrence between trisegmentectomy and lobectomy.
  • Significantly lower distant recurrence (OR 0.58) and shorter hospital stay (OR -0.94) in the trisegmentectomy group.
  • Overall morbidity was similar, but matched studies favored trisegmentectomy (OR 0.73).

Conclusions:

  • Left upper lobe trisegmentectomy and lobectomy demonstrate different recurrence patterns, with lobectomy linked to higher distant recurrence.
  • Trisegmentectomy may offer oncologic and perioperative benefits for carefully selected NSCLC patients.
  • The study is registered in PROSPERO (CRD420251066445).