Outcomes of superior segmentectomy versus lower lobectomy for superior segment Stage I non‐small‐cell lung cancer are equivalent: An analysis of 196 patients at a single, high volume institution

Abstract

ObjectivesTo determine if superior segmentectomy has equivalent overall (OS), disease‐free (DFS), and locoregional‐recurrence‐free survival (LRFS) to lower lobectomy for early‐stage non‐small‐cell lung cancer (NSCLC) in the superior segment.MethodsWe retrospectively reviewed all Stage 1 lower lobectomies for superior segment lesions and superior segmentectomies at our hospital from 2000 to 2018. Comparison statistics and Cox hazard modeling were performed to determine differences between groups and attempt to identify risk factors for OS, DFS, and LRFS.ResultsSuperior segmentectomy patients, compared with lower lobectomy patients, had more current smokers, worse forced expiratory volume in 1 s percentage, radiologic emphysema scores, clinically and pathologically smaller tumors, and more occurrences of 0 lymph nodes examined. Outcomes for superior segmentectomy compared with lower lobectomy were equivalent for 5‐year OS (67.0% vs. 75.1%, p = 0.70), DFS (56.9% vs. 60.4%, p = 0.59), and LRFS (87.9% vs. 91.3%, p = 0.46). Multivariable Cox modeling lacked utility due to no outcome differences.ConclusionsIn well‐selected patients, superior segmentectomies can have equivalent OS, DFS, and LRFS compared with lower lobectomies of superior segment tumors for early stage lung cancer. Further data are needed to provide better risk estimates.

A Retrospective Study of Effectiveness of Thoracoscopic Lobectomy and Segmentectomy in Patients with Early-Stage Non-Small-Cell Lung Cancer

“…The National Comprehensive Cancer Network suggests segmentectomy for patients with poor pulmonary reserve, for which lobectomy is not possible. A number of studies have shown that segmentectomy in patients with early-stage NSCLC can better protect lung function after surgery, which is of great significance for patients with basic pulmonary diseases, such as chronic bronchitis and emphysema, or elderly patients with poor lung function [ 14 – 16 ]. Data from this study showed that 3 days after surgery, the FEV1, FVC, and MVV levels in both groups were lower than those before surgery, but these levels in the observation group were higher than those in the control group ( P < 0.05), indicating the advantages of thoracoscopic pulmonary segmentectomy to protect lung function.…”

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally healthy patients

“…Adjusted NRCs of segmentectomy or wedge vs. lobectomy in apparently healthy patients are shown in Table 1 (16,(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52), Table 2 (16,36,42,47,48,50,(53)(54)(55)(56)(57)(58)(59)(60)(61)(62), Table 3 (36,47,48,50,(63)(64)(65)(66) and Figures S2-1…”

“…For abbreviations, footnotes, explanation of adjustment for confounding see legend for Table 3. Legend (Tables 1-3 4) (39,43,45,46,53,57,60,64,(76)(77)(78)(79)(80). The available evidence is unclear whether lesser resection increases recurrence risk.…”

Sublobar resections for lung cancer: Finally, some answers and some more questions?

“…Compounding the challenge of impartial comparison, studies evaluating sublobar resection and lobectomy often did not include enough patients to parse out anatomic location, such that an upper lobectomy was compared to lower lobe segmentectomy on the opposite side and vice versa. While a retrospective study compared only lower lobectomy to superior segmentectomy 31 and found no difference in overall or disease‐free survival, small numbers of patients continued to make it evident that randomized controlled data would be best to address this now decades‐old debate. Senior thoracic surgeons pointed the greater thoracic oncology community to the outcome of two major Phase III randomized trials as the best hope in drawing clear conclusions, the Japanese Cooperative Oncology Group (JCOG) trial 0802 33 and the Cancer and Leukemia Group‐B (CALGB) trial 140503 34…”

“…Retrospective series from larger academic institutions and databases began to emerge, some suggesting overall and recurrence-free survival (RFS) were similar between sublobar resection and lobectomy, with data conflicting on whether or not segmentectomy and wedge resection were equivalent approaches that could be grouped en mass when compared to lobectomy. [24][25][26][27]31 So conflicting was the data, that it became apparent that defining and ensuring high-quality sublobar resection in clinical research was just as paramount to an "apples-to-apples" comparison as the lack of rib spreading was to defining VATS research a decade prior. For instance, one study indicated that up to 26% of VATS wedge resections were completed with 0 lymph nodes sampled 32 -hardly a "quality sublobar resection.…”