Segmentectomy on par with lobectomy for early NSCLC
Segmentectomy and lobectomy confer similar overall survival (OS) and lung cancer-specific survival (LCSS) among patients with primary nonsmall cell lung cancer (NSCLC) of ≤20 mm without lymph node or distant metastasis, a recent study has shown.
Overall, 15,358 patients were analysed, of which 14,549 underwent lobectomies and 809 segmentectomies. The 5-year OS was 76 percent and 74.4 percent for the lobectomy group and segmentectomy group, respectively.
No significant differences in OS or LCSS were observed among patients who underwent lobectomy vs segmentectomy, as shown by the propensity-matched hazard ratio (HR) for OS (HR, 1.195; 95 percent CI, 0.993–1.439) and LCSS (HR, 1.124; 0.860–1.469). These results were also supported by the inverse propensity-weighted analysis.
Elderly patients were more likely to undergo segmentectomy vs lobectomy. In the subset of patients aged ≥75 years, those in the segmentectomy group showed comparable OS (HR, 1.17; 0.87–1.58; p=0.31) and LCSS (HR, 0.94; 0.59–1.51; p=0.81) as those in the lobectomy group.
A recent study has shown that lobectomy, segmentectomy and wedge resection are comparable surgical procedures for patients with early NSCLC. Lobectomy and segmentectomy perform better than wedge resection for tumours from 1.1–2.0 cm, while lobectomy remains the standard surgical procedure for tumours from 2.1–3.0 cm. For patients unfit for lobectomy, segmentectomy and wedge resection show similar survival rates. [Ann Thorac Surg 2018;105:1483-1491]
The investigators extracted data of patients with primary NSCLC of ≤20 mm who were diagnosed from 2000–2014 from the Surveillance, Epidemiology and End Results database. They performed a propensity score analysis between lobectomy and segmentectomy to compare the two surgical interventions.
“Standard surgical management for early stage lung cancer is lobectomy with mediastinal lymph node dissection,” the investigators noted.