Segmentectomy Versus Lobectomy in Early Non-Small Cell Lung Cancer: A Population-Based Analysis in Northern Italy

Area of Science:

• Thoracic Surgery
• Oncology
• Pulmonary Medicine

Background:

• Lung cancer early detection via low-dose computed tomography (LDCT) increases the need for minimally invasive surgical options.
• Smoking cessation remains crucial, but advances in screening necessitate refined surgical strategies for early-stage non-small cell lung cancer (NSCLC).

Purpose of the Study:

• To compare the efficacy of segmentectomy versus lobectomy for early-stage non-small cell lung cancer (NSCLC).
• To evaluate surgical outcomes including recurrence rates and survival in patients with stage I NSCLC.

Main Methods:

• Analysis of 200 patients with stage I NSCLC from a cancer registry.
• 100 patients underwent lobectomy, and 100 underwent segmentectomy.
• Outcomes assessed included loco-regional/distant recurrences, overall survival, and disease-free survival (DFS).

Main Results:

• Segmentectomy was associated with lower recurrence rates (28% vs. 35%) and fewer distant metastases (39.6% vs. 60.4%) compared to lobectomy over a 6.3-year median follow-up.
• Five-year survival was higher in the segmentectomy group (67%) versus the lobectomy group (55%), with similar trends for DFS (59% vs. 47%).
• Multivariable analysis indicated a greater risk of recurrence with lobectomy and in females, while elderly patients and those with adenocarcinoma histology showed a decreased risk.

Conclusions:

• Segmentectomy appears to be a favorable surgical approach for early-stage NSCLC, consistent with prior clinical trial findings.
• The observed benefits of segmentectomy were less pronounced in this real-world setting due to the absence of specific patient selection criteria.