Trends and Survival Outcomes of Lung Cancer Surgery in South Korea, 2015-2019

Lung cancer remains the leading cause of cancer-related deaths in South Korea, yet a comprehensive evaluation that encompasses evolving patterns of operative choice and their impact on survival outcomes by pathological factors and surgery type is lacking.

We included 36 663 patients who underwent curative lung cancer resection between 2015 and 2019. Surgical procedures were categorized as pneumonectomy, lobectomy, segmentectomy, or wedge resection, and tumors were staged according to the Surveillance, Epidemiology, and End Results classification scheme. Temporal trends in procedure frequency and age-group distribution were assessed using trend analyses. Overall survival was estimated by Kaplan-Meier analysis, and independent prognostic factors were identified using multivariable Cox proportional hazards models.

Lobectomy remained the most common operation (78.3%), while the use of segmentectomy and wedge resection increased and that of pneumonectomy declined significantly (all P for trend < 0.0001). The proportion of patients aged ≥ 76 years who received surgery rose (trend p < 0.0001). Survival was highest following segmentectomy and lobectomy across all age groups and stages. In age group-specific analyses, lobectomy conferred best survival outcomes in the 46-75-year group (adjusted hazard ratio [aHR], 0.789; 95% confidence interval [CI], 0.734-0.849), whereas segmentectomy yielded favorable survival in the ≥ 76-year group (aHR, 0.808; 95% CI, 0.676-0.967).

Between 2015 and 2019, the frequency of sublobar resections increased. Segmentectomy conferred the highest survival benefit in patients aged ≥ 76 years, whereas lobectomy was more favorable in patients aged ≤ 75 years, underscoring the importance of tailoring surgical choice to age group.