A Multicenter Study of Complex Segmentectomy Versus Wedge Resection in Clinical Stage 0-IA Non-Small Cell Lung Cancer

Abstract

BackgroundAlthough sublobar resection is widely used for lung cancer treatment, very limited data are available comparing outcomes after complex segmentectomy and wedge resection. We compared the oncological outcomes of complex segmentectomy and wedge resection for clinical stage 0-IA lung cancer via a large cohort, multicenter database using propensity score-matched analysis. Patients and MethodsWe retrospectively analyzed data from 506 clinical stage 0-IA, solid component size ≤ 2.0 cm lung cancer patients who underwent surgical resection at three institutions between 2010 and 2018. Surgical results after complex segmentectomy (n = 222) and “location-adjusted” wedge resection (n = 284) were analyzed for all patients and their propensity score-matched pairs. ResultsIn all cohort, the complex segmentectomy group tended to have a better prognosis than the wedge resection group (5 year cancer-specific survival rate, 97.4% vs. 93.7%; P = .065 and 5 year recurrence-free interval [RFI] rates, 96.9% vs. 86.1%; P = .0005). This trend was also identified in subanalyses for pure solid tumors. In 179 propensity score-matched pairs, the prognosis of patients with complex segmentectomy tended to be better than that of patients with wedge resection (5 year cancer-specific survival rates, 96.8% vs. 92.9%; 5 year RFI rates, 96.3% vs. 87.5%). Multivariable Cox regression analysis for RFI revealed that complex segmentectomy significantly reduced lung cancer recurrence compared with wedge resection (hazard ratio, 0.32; 95% confidence interval, 0.12-0.73; P = .0061). ConclusionsComplex segmentectomy can provide better oncological outcomes compared with wedge resection.