Meta-Analysis of Lobectomy, Segmentectomy, and Wedge Resection for Stage I Non-Small Cell Lung Cancer

BackgroundSurvival difference following lobectomy, segmentectomy, and wedge resection in stage I non-small cell lung cancer (NSCLC) and its subgroups remains undetermined. MethodsWe systemically searched published articles comparing recurrence-free survival (RFS), overall survival (OS), or cancer-specific survival (CSS) between lobectomy and limited resection or between segmentectomy and wedge resection. ResultsA total of 42 studies published from 1980 to 2014 enrolling 21,926 patients were included in this meta-analysis. Survival results favored lobectomy in stage IA NSCLC 2cm (combined HR: 1.530, 95% CI: 1.402-1.671, P<0.001) or patient's 65 years old (combined HR: 1.227, 95% CI: 1.003-1.502, P=0.047). Survival outcome of video-assisted thoracoscopic (VATS) sublobectomy was comparable to that of VATS lobectomy (pooled HR: 0.808, 95% CI: 0.556-1.174, P=0.263). The combined HR of segmentectomy versus lobectomy was 1.231 (95% CI: 1.070-1.417, P=0.004), while the pooled HR of wedge resection versus segmentectomy was 1.542 (95% CI: 0.856-2.780, P=0.149). ConclusionsThis study suggested that tumor size or age alone should not be the criteria to encourage sublobar resection. For stage I NSCLC, survival following segmentectomy was inferior to lobectomy. Patients undergoing intentional sublobectomy achieved comparable survival as those who received lobectomy. J. Surg. Oncol. 2015 111:334-340. (c) 2014 Wiley Periodicals, Inc.