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

Although smoking cessation remains the most effective preventive measure against lung cancer, the implementation of low-dose computed tomography screening has facilitated early tumor detection, increasing the need for less invasive surgical approaches. This study evaluated the efficacy of segmentectomy vs. lobectomy for early-stage non-small cell lung cancer (NSCLC) in northern Italy.

The analysis included 200 patients with stage I NSCLC, selected from a cancer registry. Of these, 100 underwent lobectomy and 100 underwent segmentectomy. We calculated loco-regional and distant recurrences, overall survival, and disease-free survival (DFS).

Over a median follow-up of 6.3 years, segmentectomy was associated with a lower recurrence rate (28%) compared to lobectomy (35%) and a lower incidence of distant metastases (39.6% vs. 60.4%). Multivariable analysis showed a greater risk of recurrence in patients undergoing lobectomy [OR 1.32; 95% CI: 0.71-2.45] and in females [OR 1.69; 95% CI: 0.89-3.18], while a decreased risk was observed among elderly patients over 70 years [OR 0.72; 95% CI: 0.39-1.32] and those with adenocarcinoma histology [OR 0.82; 95% CI: 0.41-1.64]. Five-year survival was higher in the segmentectomy group (67%; 95% CI: 57-76) compared to the lobectomy group (55%; 95% CI: 45-65); a similar result was observed for DFS: 59% (95% CI: 48-68) versus 47% (95% CI 37-57). The risk of death appeared lower in the segmentectomy group [HR 0.85; 95% CI: 0.59-1.22].

The outcomes appear to favor segmentectomy, as previously demonstrated in clinical trials. The observed effects are less pronounced, due to the absence of patient selection in this real-world setting.