Assessing Outcomes in Clinical Stage I Non-small Cell Lung Tumors up to Two Centimeters in Diameter in Segmentectomy vs. Lobectomy: Systematic Review and Meta-analysis.

Abstract

Lung cancer, which accounted for 1.8 million fatalities in 2020, necessitates the investigation of optimal surgical approaches for early-stage cases. Although lobectomy has long been associated with successful results, the growing interest in segmentectomy as an alternative procedure warrants further examination. The primary objective of this study was to compare segmentectomy with lobectomy as a viable treatment option for early-stage lung cancer. Our systematic review of NSCLC studies comparing lobectomy to segmentectomy followed the PRISMA guidelines and used a random-effects model. We extracted the patient characteristics, outcomes (overall survival, disease-free survival, and recurrence), and postoperative complications. Statistical analyses included hazard ratios, risk ratios, sensitivity assessments, and bias evaluations, all of which were performed using a random-effects model to account for heterogeneity among studies. Twelve studies involving 6049 patients revealed that segmentectomy and lobectomy demonstrated comparable overall survival (OS), with an HR of 0.99 (95% CI 0.81-1.21, p = 0.90). At 24 and 60 months, OS rates were RR = 0.95 (95% CI 0.92-0.97, p = 0.0001) and RR = 0.81 (95% CI 0.67-0.98, p = 0.03), respectively. Similarly, disease-free survival (DFS) results were comparable (HR = 1.01; 95% CI 0.86-1.19, p = 0.87). DFS at 24 and 60 months demonstrated RR = 0.97 (95% CI 0.95-1.0, p = 0.05) and RR = 0.82 (95% CI 0.70-0.97, p = 0.02), respectively. The risk of lung cancer recurrence was similar between the two groups (RR = 0.98; 95% CI 0.75-1.30, p = 0.26). Our study revealed that segmentectomy and lobectomy had identical oncological outcomes in terms of OS and DFS. Although segmentectomy showed a slightly higher complication rate, further research is needed to draw definitive conclusions, emphasizing the importance of additional randomized trials.