Margin Quality Analysis and Risk Factors Associated With Insufficient Margins Following Segmentectomy for Small-Sized...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Segmentectomy is a recognized non-inferior treatment to lobectomy for small non-small cell lung cancer (NSCLC).
• Ensuring adequate surgical margins is crucial for oncologic outcomes in lung cancer surgery.
• Identifying factors influencing margin quality in segmentectomy is essential for optimizing surgical planning and patient selection.

Purpose of the Study:

• To identify patient and tumor characteristics associated with achieving sufficient surgical margins during segmentectomy for small NSCLC.
• To provide data that can help surgeons anticipate and mitigate risks of positive or close margins.

Main Methods:

• Retrospective review of 667 patients with small NSCLC (≤2 cm) who underwent segmentectomy.
• Definition of sufficient margin as ≥ maximum tumor diameter.
• Logistic regression analysis to determine factors associated with insufficient margins.

Main Results:

• Sufficient margins were achieved in 86.5% of patients.
• Factors significantly associated with insufficient margins included larger tumor size, longer tumor-to-pleura distance, shorter tumor-to-segmental bronchus distance, and intersegmental tumor location.
• Optimal cutoff values were identified for tumor size (1.1 cm), tumor-to-pleura distance (3.0 cm), and tumor-to-segmental bronchus distance (5.2 cm).

Conclusions:

• Tumor size, proximity to the pleura and segmental bronchus, and subsegmental location are key factors influencing margin adequacy in segmentectomy.
• Surgeons should consider these high-risk features when planning segmentectomy to minimize the risk of inadequate margins.