Long-term prognosis of complex versus simple segmentectomy for stage I non-small cell lung cancer

This study compared the long-term outcomes of complex versus simple segmentectomy in patients with stage I non-small cell lung cancer (NSCLC), focusing on disease-free survival (DFS) and overall survival (OS). With advances in early cancer detection, the role of complex segmentectomy for small, early-stage tumors warrants evaluation.

We retrospectively reviewed patients with clinical stage I NSCLC who underwent anatomical segmentectomy from 2007 to 2019 at the Tri-Service General Hospital in Taiwan. Procedures were categorized as complex or simple segmentectomy according to the number and anatomical configuration of resected segments. Clinicopathologic features, perioperative outcomes, and long-term oncologic results were compared. DFS and OS were analyzed using Kaplan-Meier estimates and compared by the log-rank test.

Among 362 patients, 154 underwent simple segmentectomy and 208 underwent complex segmentectomy. Baseline demographic and tumor characteristics were similar between groups. There were no significant differences in DFS (log-rank P = 0.249) and OS (log-rank P = 0.457) at three and five years between the groups. Between the groups, complex segmentectomy yielded a higher median number of dissected lymph nodes, particularly from the N2 station, while operative time, tumor locations, and complication rates were comparable.

With the aid of precise preoperative imaging simulation, localization techniques, and intraoperative guidance, complex segmentectomy achieves long-term outcomes equivalent to those of simple segmentectomy for early-stage NSCLC.