Comparative Outcomes of Segmentectomy Versus Lobectomy for Solid Dominant Lung Cancer with a Tumor Diameter of 2-3 cm

Background/Objectives: Several studies have demonstrated feasible oncologic outcomes of segmentectomy for pure-solid or solid-dominant non-small cell lung cancer (NSCLC) measuring ≤2 cm in diameter and ground-glass opacity (GGO)-dominant NSCLC up to 3 cm in maximum tumor size. However, the applicability of segmentectomy for solid-dominant NSCLC with a tumor diameter of 2-3 cm remains controversial. This retrospective study aimed to investigate the outcomes of segmentectomy for solid-dominant NSCLC with a tumor diameter of 2-3 cm. Methods: We included patients who underwent lung cancer surgery at Tokyo Women's Medical University Hospital, Tokyo, Japan, from January 2011 to December 2017. The number of patients included in this study was 743. Of the 96 eligible patients, 76 and 20 underwent lobectomy and segmentectomy, respectively. Results: The lobectomy and segmentectomy groups had similar 5-year overall survival rates (93.7% vs. 94.4%, respectively; HR 0.693, 95% CI 0.183-2.621, p = 0.586) and 5-year recurrence-free survival rates (75.8% vs. 83.6%, respectively; HR 0.639, 95% CI 0.188-2.171, p = 0.468). The recurrence pattern was not significantly different between the lobectomy and segmentectomy groups (locoregional 11.8% vs. 10.0%, and distant 10.5% vs. 5.0%, respectively; p = 0.679). Multivariable Cox regression analysis demonstrated that surgical procedure was not independently associated with OS or RFS after adjustment for confounders. Conclusions: Segmentectomy may be a feasible option for selected patients with solid-dominant NSCLC measuring 2-3 cm in diameter.