Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non-small cell lung cancer

Objective: We hypothesize that segmentectomy is associated with similar recurrence-free and overall survival when compared with lobectomy in the setting of patients with clinical T1cN0M0 non?small cell lung cancer (NSCLC;>2-3 cm), as defined by the American Joint Committee on Cancer 8th edition staging system. Methods: We performed a single-institution retrospective study identifying patients undergoing segmentectomy (90) versus lobectomy (279) for T1c NSCLC from January 1, 2003, to December 31, 2016. Univariate, multivariable, and propensity score?weighted analyses were performed to analyze the following endpoints: freedom from recurrence, overall survival, and time to recurrence. Results: Patients undergoing segmentectomy were older than patients undergoing lobectomy (71.5 vs 68.8, respectively, P = .02). There were no differences in incidence of major complications (12.4% vs 11.7%, P = .85), hospital length of stay (6.2 vs 7 days, P = .19), and mortality at 30 (1.1% vs 1.7%, P = 1) and 90 days (2.2% vs 2.3%, P = 1). In addition, there were no statistical differences in locoregional (12.2% vs 8.6%, P = .408), distant (11.1% vs 13.9%, P = .716), or overall recurrence (23.3% vs 22.5%, P = 1), as well as 5-year freedom from recurrence (68.6% vs 75.8%, P = .5) or 5-year survival (57.8% vs 61.0%, P = .9). Propensity score? matched analysis found no differences in overall survival (hazard ratio [HR], 1.034; P = .764), recurrence-free survival (HR, 1.168; P = .1391), or time to recurrence (HR, 1.053; P = .7462). Conclusions: In the setting of clinical T1cN0M0 NSCLC, anatomic segmentectomy was not associated with significant differences in recurrence-free or overall survival at 5 years. Further prospective randomized trials are needed to corroborate the expansion of the role of anatomic segmentectomy to all American Joint Committee on Cancer 8th Edition Stage 1A NSCLC. (J Thorac Cardiovasc Surg 2021;161:1639-48)

Automated summary

This study found that anatomic segmentectomy was not associated with significant differences in recurrence-free or overall survival at 5 years in patients with clinical T1cN0M0 NSCLC. Propensity score-matched analysis also showed no differences in overall survival, recurrence-free survival, or time to recurrence. Further prospective randomized trials are needed to confirm the role of anatomic segmentectomy in all Stage 1A NSCLC patients according to the AJCC 8th Edition staging system.