Loco-regional Recurrence After Segmentectomy for Peripheral and Radiologically Solid-dominant Tumours

Segmentectomy is a standard treatment for small-sized, peripherally located, and radiologically solid-dominant non-small cell lung cancer. However, its effectiveness in loco-regional control compared with lobectomy for such tumours remains undetermined.

We evaluated the clinicopathological findings, recurrence patterns, and prognosis of patients with radiologically determined ≤2-cm sized, solid-dominant, and peripheral non-small cell lung cancer without lymph node involvement clinically. These patients underwent complete resections via segmentectomy (n = 332) or lobectomy (n = 609) between 2010 and 2020. Median follow-up duration for anonymized patients was 48.8 months.

Among the 941 patients, loco-regional recurrence occurred in 7 (2%) patients following segmentectomy and in 30 (5%) following lobectomy (P = .037). Surgical stump recurrences occurred in 3 (1%) patients in a segmentectomy group and in 5 (0.8%) patients in a lobectomy group. Among patients with pure solid tumours, no significant difference in loco-regional recurrence was noted between the segmentectomy (7 patients, 4%) and lobectomy (27 patients, 7%) groups (P = .11). Surgical stump recurrence occurred in 3 (1.5%) patients following segmentectomy and in 3 (0.7%) patients following lobectomy. Fine-Gray proportional hazard regression analysis with adjusted variables, including age, sex, Brinkman index, solid tumour size, presence of ground glass opacity, and SUVmax, revealed that the surgical procedure was not a risk factor for loco-regional recurrence.

Regardless of tumour malignant grade, segmentectomy provides comparable local control with lobectomy for selected small-sized peripheral non-small cell lung cancer.