Segmentectomy versus lobectomy for small‐sized pure solid non–small cell lung cancer

Abstract

Background: Segmentectomy has been recommended for ground glass opacity (GGO)-dominant small-sized non-small cell lung cancer (NSCLC) or those with GGO component. Pure solid NSCLC is a special sub-type and has an inferior prognosis. Whether segmentectomy could achieve comparable long-term outcomes with lobectomy for pure solid small-sized NSCLC remained controversial. This study aimed to compare the prognosis of segmentectomy and lobectomy for pure solid NSCLC. Methods: NSCLC patients with a pure solid nodule (≤2 cm) who received segmentectomy or lobectomy between January 2010 and June 2019 were retrospectively screened. Log-rank test, univariable, and multivariable Cox regression analyses were used for prognostic comparison. Further, the propensity score matching analysis was adopted to yield a matched cohort. Results: After screening, 344 pure solid NSCLC patients with a median follow-up time of 56 months were reserved. Among them, 98 patients underwent segmentectomy and the other 246 subjects received lobectomy. The lobectomy group had a larger tumor size, a higher rate of lymph node metastasis than the segmentectomy arm. Generally, patients with segmentectomy had a better disease-free survival (DFS) (p = 0.011) and overall survival (OS) (p = 0.028) than those with lobectomy. However, the multivariable Cox regression analysis indicated that no significant survival difference existed between segmentectomy and lobectomy after adjusting the potential confounding factors (DFS: hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.30-1.77, p = 0.476; OS: HR, 0.36; 95% CI, 0.08-1.59, p = 0.178). Consistently, in the propensity score matched cohort, segmentectomy (n = 74) yielded similar DFS (p = 0.960) and OS (p = 0.320) with lobectomy (n = 74). Conclusions: Segmentectomy could achieve comparable oncological outcomes with lobectomy for pure solid small-sized NSCLC.

CTR > 0.7 predicts the subgroup of lung adenocarcinomas ≤ 2 cm at risk of poor outcome treated by sublobar resection compared to lobar resection

“…However, among patients with CTR ≥ 0.7, sublobar resection was associated with poorer outcomes than lobar resection, which is consistent with previous studies [ 19 , 20 ]. In contrast, our results were inconsistent with those of Li et al [ 21 ], who showed that sublobar resection could achieve oncological outcomes comparable to lobar resection for pure solid small-sized NSCLC. This contradiction may be caused by our cases precluding lymph node metastasis, while the lobar resection group had a higher rate of lymph node metastasis than the sublobar resection arm, acquiring more positive events in the lobar resection group.…”

Pursuit of Precision: Lobar Split Cone-Shaped Subsegmentectomy for Lung Nodules in Complex Positioning

“…The main treatment for small lung nodules is surgery, which includes lobectomy, segmentectomy and wedge resection [18,19]. Recently, segmentectomy has been regarded as a common type of surgery [20,21]. In this study, we demonstrated the use of a true lung segmentectomy technique, lobar split cone-shaped subsegmentectomy.…”