# Trends and Survival Outcomes of Lung Cancer Surgery in South Korea, 2015–2019

## TL;DR

This study analyzed lung cancer surgery trends in South Korea from 2015 to 2019 and found that surgical choices and survival outcomes vary significantly by age group.

## Contribution

The study provides age-specific insights into optimal surgical choices for lung cancer patients in South Korea.

## Key findings

- Lobectomy was the most common procedure, but segmentectomy and wedge resection usage increased over time.
- Lobectomy provided the best survival outcomes for patients aged 46–75, while segmentectomy was best for those aged ≥76.
- Pneumonectomy use declined significantly during the study period.

## Abstract

Lung cancer remains the leading cause of cancer‐related deaths in South Korea, yet a comprehensive evaluation that encompasses evolving patterns of operative choice and their impact on survival outcomes by pathological factors and surgery type is lacking.

We included 36 663 patients who underwent curative lung cancer resection between 2015 and 2019. Surgical procedures were categorized as pneumonectomy, lobectomy, segmentectomy, or wedge resection, and tumors were staged according to the Surveillance, Epidemiology, and End Results classification scheme. Temporal trends in procedure frequency and age‐group distribution were assessed using trend analyses. Overall survival was estimated by Kaplan–Meier analysis, and independent prognostic factors were identified using multivariable Cox proportional hazards models.

Lobectomy remained the most common operation (78.3%), while the use of segmentectomy and wedge resection increased and that of pneumonectomy declined significantly (all P for trend < 0.0001). The proportion of patients aged ≥ 76 years who received surgery rose (trend p < 0.0001). Survival was highest following segmentectomy and lobectomy across all age groups and stages. In age group–specific analyses, lobectomy conferred best survival outcomes in the 46–75‐year group (adjusted hazard ratio [aHR], 0.789; 95% confidence interval [CI], 0.734–0.849), whereas segmentectomy yielded favorable survival in the ≥ 76‐year group (aHR, 0.808; 95% CI, 0.676–0.967).

Between 2015 and 2019, the frequency of sublobar resections increased. Segmentectomy conferred the highest survival benefit in patients aged ≥ 76 years, whereas lobectomy was more favorable in patients aged ≤ 75 years, underscoring the importance of tailoring surgical choice to age group.

Among 36 663 Korean patients undergoing curative lung cancer resection (2015–2019), the use of segmentectomy and wedge resection increased while pneumonectomy declined. In multivariable Cox models, lobectomy was associated with the most favorable survival in patients aged 46–75 years (adjusted hazard ratio [aHR] 0.789; 95% CI 0.734–0.849), whereas segmentectomy was most favorable in patients aged ≥ 76 years (aHR 0.808; 95% CI 0.676–0.967), supporting age‐tailored procedure selection.