Oncological Outcome of Minimally Invasive Single-Port Segmentectomy Compared to Lobectomy for Stage IA Lung Cancer

TL;DR

This study compares the long-term outcomes of two lung cancer surgeries and finds that segmentectomy is a viable option for small tumors, but lobectomy may be better for slightly larger ones.

Contribution

The study provides new evidence on the oncological outcomes of uniportal segmentectomy versus lobectomy for stage IA lung cancer.

Findings

Segmentectomy showed similar 5-year survival to lobectomy for tumors ≤2 cm.

For tumors 2–3 cm, segmentectomy showed a trend toward higher recurrence and lower survival, though not statistically significant.

Lymphatic invasion was an independent predictor of mortality in both groups.

Abstract

Surgery is the primary treatment for early-stage lung cancer, and traditionally, it involves removing an entire lung lobe. In recent years, smaller and less invasive operations—such as segmentectomy, which removes only part of the lobe—have become more common. In this study, we examined the long-term outcomes of over 230 patients who underwent surgery through a minimally invasive “uniportal” technique. We found that, for tumors up to 2 cm in size, segmentectomy provided outcomes similar to lobectomy. In tumors between 2 and 3 cm, we observed an increased risk of recurrence and a lower overall survival following segmentectomy, although these differences were not significant. These findings suggest that segmentectomy is a valid oncological treatment for selected patients with specific lung cancer characteristics, preserving more lung tissue, and can be a solid alternative for these individuals. Our results may help guide surgeons in choosing the most appropriate approach based on individual tumor size and characteristics.

Background and Objectives: Lobectomy has traditionally been the gold standard for surgical treatment of early-stage non-small cell lung cancer (NSCLC). However, recent randomized trials suggest anatomical segmentectomy may offer comparable outcomes for selected patients with small, peripheral tumors. The role of segmentectomy in stage IA3 tumors remains less apparent in the context of video-assisted thoracoscopic surgery. Methods: This retrospective study analyzed 232 patients with pathological stage IA NSCLC who underwent uniportal anatomical segmentectomy (n = 160) or lobectomy (n = 72). Clinicopathological characteristics, recurrence rates, and overall survival (OS) were compared, with subgroup analysis for IA1–IA3 tumors. Results: The 5-year OS was 76.9% for segmentectomy and 87.5% for lobectomy (p = 0.105). Recurrence occurred in 15.8% of segmentectomy patients and 11.3% of lobectomy patients. In IA3 tumors, recurrence rates were higher after segmentectomy (23.5% vs. 18.2%), though not statistically significant. Lymphatic invasion was an independent predictor of mortality. No significant differences were found in tumor size, histologic subtype, or nodal involvement between groups. Conclusions: Uniportal anatomical segmentectomy may be a feasible alternative to lobectomy for stage IA NSCLC, especially for tumors ≤ 2 cm. For IA3 tumors, caution is advised given a trend toward worse outcomes. Careful patient selection and adherence to oncologic principles are essential.

Figures