Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a real-world propensity score-matched analysis

Although lobectomy is considered the standard surgical treatment for stage I non-small cell lung cancer (NSCLC). Recently, anatomical segmentectomy may represent an acceptable oncologic option for these patients. The study aims to compare perioperative and long-term outcomes between anatomical segmentectomy and lobectomy for stage I NSCLC using propensity score matching (PSM) in a single thoracic surgery centre.

We retrospectively analyzed 60 patients with stage I NSCLC who underwent pulmonary resection between 2017-2024. After 1:1 PSM, 50 patients (25 per group) were included. All patients underwent radical lymphadenectomy with ≥3 mediastinal stations dissected. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Secondary endpoints included recurrence patterns, perioperative outcomes, and oncological adequacy.

After matching, baseline characteristics were well-balanced except for diffusing capacity for carbon monoxide (DLCO) (74.0% vs. 81.5%, P=0.01). All patients achieved R0 resection with comparable lymph node yields (17.3 vs. 16.8 nodes, P=0.32). Segmentectomy was associated with worse DFS [hazard ratio (HR) 2.06, 95% confidence interval (CI): 1.12-3.80, P=0.02] but similar OS (HR 0.70, 95% CI: 0.12-4.07, P=0.69). Overall mortality was 16% (4 deaths per group). Recurrence occurred in 10% of patients (12% segmentectomy vs. 8% lobectomy, P=0.64); however, given the low number of events (n=5), these comparisons should be interpreted with caution. Median follow-up was 24 months.

Despite higher recurrence risk, anatomical segmentectomy with radical lymphadenectomy achieved equivalent OS to lobectomy for selected stage I NSCLC ≤2 cm. The relatively small sample size (n=50) limits statistical power, and these findings should be considered exploratory and hypothesis-generating. This parenchyma-sparing approach represents a valuable option in experienced centers, preserving pulmonary function while maintaining oncological adequacy. Careful patient selection and meticulous surgical technique remain paramount for optimal outcomes.