Should segmentectomy indications be extended to NSCLC smaller than 3 cm without lymph node involvement? A retrospective single-center study

Introduction

Surgical resection remains the standard treatment for stage IA non-small cell lung cancers (NSCLC). The dual objective of this study is to compare long-term outcomes of lobectomies and segmentectomies for stage IA NSCLC and to identify prognostic factors for resected stage IA NSCLC.

Materials and Methods

This is a retrospective monocentric study including patients diagnosed with NSCLC smaller than 3 cm, without lymph node involvement, from November 2015 to November 2021. The primary endpoint was event-free survival (EFS), defined as time from surgery to recurrence or all-cause death. Secondary endpoints included overall survival, recurrence-free survival, and short-term postoperative outcomes (length of stay, drainage duration, 30-day mortality, and postoperative complications). Prognostic factors were analyzed using multivariate Cox regression adjusted for variables identified in univariate analysis.

Results

A total of 457 patients underwent surgery for stage cIA NSCLC during the 11study period. Of these, 176 (38.5 %) had a segmentectomy, and 281 (61.5 %) underwent lobectomy. Among patients with cT1N0 tumors, the 5-year event-free survival did not significantly differ between the segmentectomy and lobectomy groups (adjusted HR = 0.59 (0.32; 1.08), p = 0.086), with 5-year event-free rates of 75.0 % and 83.0 %, respectively (p = 0.054). Multivariate analysis revealed an association between nodule type (solid vs. ground-glass or mixed) and event-free survival (death and/or recurrence) ([adjusted HR =2.07 (1.17–3.66), p = 0.01)]. Vascular and/or lymphatic invasion is associated with a decrease in event-free survival (recurrence or death) [adjusted HR = 2.25 (1.29; 3.92), p = 0.004]. Conversion from segmentectomy to lobectomy occurred in 6 patients (3.4 %), and they were included in the lobectomy group for analysis.

Conclusion

For patients with clinical stage cIA NSCLC, segmentectomy appears to offer comparable oncologic outcomes to lobectomy. Tumor characteristics, including radiological appearance and histological factors, should be carefully considered when selecting the appropriate surgical strategy. Prospective multicenter studies are needed to confirm these findings.