Long-Term Results of Segmentectomy vs. Lobectomy for c-Stage IA Lung Cancer: A Real-Life Study with a Propensity Score Analysis Based on a National Cohort

TL;DR

This study compares segmentectomy and lobectomy for early-stage lung cancer and finds similar long-term survival and recurrence rates.

Contribution

The study provides real-life evidence supporting segmentectomy as a valid alternative to lobectomy for c-stage IA lung cancer.

Findings

Overall recurrence was 23.7% in both the segmentectomy and lobectomy groups.

Locoregional recurrence was higher in segmentectomy, while distant recurrence was higher in lobectomy.

Five-year overall survival was similar between the two groups at around 73%.

Abstract

Background/Objectives: The objective was to compare the results of segmentectomy and lobectomy in the treatment of c-stage IA lung cancer in terms of tumor recurrence and 5-year survival. Methods: An observational study was performed using 3533 patients included in the registry of the Spanish VATS Group (GEVATS) of the Spanish Society of Thoracic Surgery (SECT) between 2016 and 2018. A total of 1004 lobectomies and 83 segmentectomies in c-stage IA were selected. Two comparable groups were selected through 2:1 propensity score matching with patient-, tumor- and surgery-related variables, leaving 166 lobectomies and 83 segmentectomies. Tumor recurrence was analyzed by Fisher’s test and overall, cancer-specific, recurrence-free and disease-free survival by Kaplan-Meier and Log-rank tests. Results: Overall recurrence was 23.7% in both groups, with a predominance of locoregional recurrence in segmentectomy (16.2% vs. 11.2%) and distant recurrence in lobectomy (12.5% vs. 7.5%). There was no difference between the two groups in any of the survival types. Overall survival at 5 years was 73.5% (95% CI: 65.5–82.4%) in the lobectomy group vs. 73.1% (95% CI: 60.1–88.9%) in the segmentectomy group. Conclusions: Anatomic segmentectomy may be a valid option in the treatment of c-stage IA lung cancer since the recurrence and long-term survival outcomes compared to lobectomy are equivalent.

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