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Segmentectomy Or Lobectomy In T1n0m0 Non-small Cell Lung Carcinomas
Gizem Özçıbık Işık
1,
Akif Turna2, Serhan Tanju
3, Celal Buğra Sezen
4, Hasan Volkan Kara
2, Hüseyin Melek
5, Ali Çelik
6, Muhammet Sayan
6, Merve Satır Türk
6, Suat Erus
3, Cengiz Gebitekin
7, Altemur Karamustafaoğlu
8, Burak Özer
3, Şükrü Dilege
3.
1Bolu State Hospital, Bolu, Turkey,
2Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, ISTANBUL, Turkey,
3Koc University Medical Faculty, ISTANBUL, Turkey,
4edikule Chest Diseases and Thoracic Surgery Training and Research Hospital, ISTANBUL, Turkey,
5Bursa Uludag University Medical Faculty, Bursa, Turkey,
6Gazi University Medical Faculty, Ankara, Turkey,
7Bursa Uludag University Medical Faculty, ISTANBUL, Turkey,
8Trakya University Faculty of Medicine, Edirne, Turkey.
BACKGROUND:Recent randomized prospective studies have demonstrated comparable survival rates between segmentectomy and lobectomy in patients with peripherally located, N0 non-small cell lung cancer measuring 2 cm or smaller. In this study, we aimed to evaluate the impact of the surgical approach (segmentectomy vs. lobectomy) on survival outcomes in patients with T1N0 NSCLC.
METHODS:This study was designed as a retrospective, multicenter analysis utilizing data from six thoracic surgery clinics in Turkey. Initially, 317 patients undergoing segmentectomy were compared with 252 patients who underwent lobectomy. Following 1:1 matching based on demographic data and allowing a 20% matching error rate, 223 patients were included in the final analysis for each group. The segmentectomy and lobectomy groups were compared using categorical, parametric, and survival data.
RESULTS:After propensity score matching, the groups were well-balanced in terms of demographic characteristics. The segmentectomy group had a significantly higher rate of VATS procedures and adenocarcinoma diagnoses compared to the lobectomy group (both p < 0.001). Conversely, the lobectomy group exhibited significantly higher values for tumor size, pleural invasion, perineural invasion, lymphatic invasion, vascular invasion, and STAS (p<0.001, p<0.001, p<0.001, p<0.001, and p=0.02 respectively).Segmentectomy group had a shorter hospital stay and a lower incidence of pulmonary complications (p<0.001 and p=0.002, respectively). Although the segmentectomy group demonstrated better median survival the survival difference between the two groups was not statistically significant (p=0.062, Figure 1).Independent factors associated with poor prognosis included non-adenocarcinoma histology (p<0.001, HR:0.47, 95% CI:0.29-0.73) and vascular invasion (p=0.017, HR:1.93, 95% CI:1.12-3.33).
CONCLUSIONS:Our study demonstrated that in patients with T1N0 NSCLC, segmentectomy provided survival outcomes comparable to those of lobectomy. Additionally, the segmentectomy group had a shorter postoperative hospital stay and a lower incidence of pulmonary complications, making it a potentially preferable option for appropriately selected patients. However, it is important to note that non-adenocarcinoma histology and vascular invasion were identified as poor prognostic factors for survival, underscoring the need for careful follow-up and potentially additional interventions in such cases.
Table 1: Demography data | Segmentectomy | Lobectomy | p Value |
| Age | 62.7 ± 9.0 | 63.4 ± 8.8 | 0.782 |
| Gender-Female-Male | 85138 | 73150 | 0.235 |
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