Does anatomic segmentectomy have better outcomes than wedge resections in stage I NSCLC patients treated by sub-lobar resection?

Abstract

e18506 Background: As compared to wedge resection (WR), anatomic segmentectomy (AS) may result in a more thorough resection because it allows bronchial and vascular dissection in a manner similar to a lobectomy and greater access for lymphadedectomy. The purpose of our study is to assess if AS allows for lower loco-regional (LR)/distant (DR) recurrences, improved overall survival (OS), and greater ability to resect lymph nodes as compared to WR. Methods: A multi-institutional database of consecutive patients undergoing surgical resection with negative margins for Stage I NSCLC FROM 1998-2009 was used. 2,300 patients had stage I NSCLC(<4cm) underwent surgical resection from which 267 received either AS or WR and were investigated. Variables studied to assess their impact on LR, DR, and OS included age, sex, surgical procedure, hilar node (N1) sampling, histology, LVI, tumor size, tumor grade, and visceral pleural involvement. Cox proportional hazard modeling was used for multivariate analysis. Results: Median follow-up was 188 weeks. The frequency of AS and WR were 3.3% and 12.7%, respectively. We compared LR and DR. There were higher numbers of N1 and N2 removed nodes in patients who underwent AS (p<0.05). There was no significant difference in rates of LR (p=0.58), DR (p=0.4), or OS (p =0.24) between WR and AS in multivariate analysis. Conclusions: Despite more extensive lymphadenectomy, AS is associated with similar rates of LR, DR and OS as WR. [Table: see text]