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

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonology

Background:

• Segmentectomy is a standard treatment for small, peripheral, solid-dominant non-small cell lung cancer (NSCLC).
• The comparative effectiveness of segmentectomy versus lobectomy for loco-regional control in these specific NSCLC cases remains unclear.

Purpose of the Study:

• To compare the loco-regional control effectiveness of segmentectomy and lobectomy.
• To evaluate recurrence patterns and prognosis in patients with specific NSCLC characteristics undergoing these surgical procedures.

Main Methods:

• Retrospective analysis of 941 patients with ≤2-cm, solid-dominant, peripheral NSCLC without clinical lymph node involvement.
• Patients underwent either segmentectomy (n=332) or lobectomy (n=609) between 2010 and 2020.
• Median follow-up was 48.8 months, with analysis of recurrence patterns and prognostic factors.

Main Results:

• Loco-regional recurrence occurred in 2% of segmentectomy patients versus 5% of lobectomy patients (P=.037).
• Among pure solid tumors, loco-regional recurrence was 4% for segmentectomy and 7% for lobectomy (P=.11).
• Multivariable analysis indicated that the surgical procedure was not a risk factor for loco-regional recurrence.

Conclusions:

• Segmentectomy provides comparable local control to lobectomy for selected small-sized, peripheral NSCLC.
• This finding holds true regardless of tumor malignant grade for these specific patient selections.