Lobectomy and segmentectomy have similar efficacy in stage I NSCLC

By Joanna Lyford, Senior medwireNews Reporter

Lobectomy and anatomic segmentectomy appear to offer similar perioperative and oncological outcomes in patients with stage I non-small-cell lung cancer (NSCLC), analysis suggests.

Noting that anatomic segmentectomy is considered to be “a compromised procedure” by many surgeons, Rodney Landreneau (University of Pittsburgh, Pennsylvania, USA) and colleagues say that segmentectomy nevertheless may be a valid alternative to lobectomy in properly selected patients.

The team used propensity-score matching to compare outcomes of 392 patients treated with segmentectomy and 800 who underwent lobectomy. This gave two treatment groups of 312 patients who were matched for preoperative variables known to influence outcomes, including gender, smoking status, lung function, tumour size and various comorbid conditions.

The patients all had clinical stage I disease and their mean age was 68.4 years. Most patients were current or former smokers with a moderate degree of pulmonary impairment and the mean tumour size was 2.2 cm.

Overall morbidity was similar with segmentectomy (36.9%) and lobectomy (32.7%). Mortality at 30 and 90 days was 1.2% and 2.6%, respectively, with segmentectomy and 2.5% and 4.8%, respectively, with lobectomy.

At a mean follow-up of 5.4 years, there was no difference between the groups in rates of locoregional or distant recurrence. This was true in subgroups of patients with T1a, T1b and T2a tumours.

In multivariate analysis, age, male gender, preoperative chronic obstructive pulmonary disease, preoperative coronary artery disease and tumour size all predicted overall survival. However, the type of resection approach was not significantly associated with either recurrence or overall survival, with hazard ratios of 1.11 and 1.17, respectively.

The investigators say their findings suggest that anatomic segmentectomy “can achieve perioperative (morbidity and mortality) and oncologic outcomes (recurrence and survival) that are not statistically significantly different compared with those achieved by lobectomy for clinical stage I disease, and thus anatomic segmentectomy should be considered as a valid alternative to lobectomy in properly selected patients.”

Results from two large randomised controlled trials, currently underway, will be necessary to confirm the results, they add.

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