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Updated: May 14, 2026
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Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Segmentectomy Versus Lobectomy in NSCLC With Pathologically Invasive Features: A Post Hoc Supplementary Analysis of
Shinya Katsumata1, Atsushi Kamigaichi2, Takaki Akamine3
1Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Summary
Segmentectomy may offer better overall survival for non-small cell lung cancer (NSCLC) with invasive features compared to lobectomy. However, segmentectomy increases the risk of locoregional relapse, warranting careful consideration.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Segmentectomy is a standard treatment for early-stage non-small cell lung cancer (NSCLC).
- The comparative efficacy of segmentectomy versus lobectomy for NSCLC with pathologically invasive features remains uncertain.
Purpose of the Study:
- To compare the survival outcomes of segmentectomy and lobectomy in patients with clinical stage IA NSCLC and pathologically invasive features.
Main Methods:
- A post-hoc analysis of the JCOG0802/WJOG4607L phase 3 trial was performed.
- Included patients had clinical stage IA NSCLC (≤2 cm) with lymphatic, vascular, or pleural invasion, or lymph node metastasis.
- Primary outcome was overall survival (OS); secondary outcomes included relapse-free survival (RFS) and locoregional relapse.
Main Results:
- Segmentectomy showed a trend toward improved OS (HR 0.657) and significantly reduced non-cancer deaths (HR 0.359).
- No significant differences were observed in RFS or lung cancer-specific death between the groups.
- Segmentectomy was associated with a significantly higher cumulative incidence of locoregional relapse (HR 2.234).
Conclusions:
- Segmentectomy demonstrates potential for improved overall survival in NSCLC with invasive features compared to lobectomy.
- The increased risk of locoregional relapse following segmentectomy necessitates careful patient selection and monitoring.
