Survival benefit with lobectomy vs. sublobar resection in octogenarians with clinical stage IA lung cancer

To preserve the lung function, sublobar resection is considered better than lobectomy in octogenarians with clinical stage IA (c-stage IA) lung cancer. We explored the survival benefits of lobectomy versus sublobar resection in octogenarians undergoing surgery for c-stage IA lung cancer.

Between April 2004 and December 2024, 289 of the 2,650 patients who underwent surgery for lung cancer were octogenarians with c-stage IA. We analyzed survival and prognostic factors using propensity score matching to compare lobectomy and sublobar resection.

The median patient age was 82 years (range, 80-91 years), and the 90-day mortality rate was 0.7%. Lobectomy, segmentectomy, and wedge resection were performed in 109 (37.7%), 86 (30.0%), and 94 (32.5%) patients, respectively. The 5-year OS rates for lobectomy, segmentectomy, and wedge resection were 61.7%, 74.0%, and 63.0%, respectively (p = 0.382). After propensity score matching, no significant differences in survival were observed between the lobectomy and sublobar resection groups (p = 0.382). There was no difference in the 5-year cumulative incidence of cancer-related deaths between lobectomy (10.5%) and sublobar resection (8.7%) (p = 0.822). A multivariate analysis confirmed that lower performance status was a significant prognostic factor (p < 0.001).

The surgical procedure type did not affect overall survival in octogenarians with c-stage IA lung cancer, and performance status was a key prognostic factor.