Real-world postoperative outcomes of segmentectomy versus lobectomy for lung cancer.

Abstract

The preference for lobectomy over sublobar resections as the standard of care for early-stage non-small-cell lung cancer (NSCLC) was widely accepted after the Lung Cancer Study Group published the first randomized controlled trial with patients recruited from the 1980s [1]. Since then, improvements in preoperative imaging, refined patient selection, minimally invasive surgical techniques and appreciation of tumour heterogeneity have renewed interest in the utilization of sublobar resection for patients with resectable NSCLC, particularly in Japan. A systematic review and meta-analysis in 2015 identified all the relevant studies that compared patients with NSCLC who underwent sublobar resections versus lobectomies, and divided these patients into an ‘intentionally selected’ group, in which patients could have undergone either operation, and a ‘compromised’ group, in which patients underwent sublobar resections as they could not tolerate a lobectomy [2]. When clinical outcomes were compared between segmentectomy versus lobectomy in the ‘intentionally selected’ group, it was found that no significant differences were identified for overall survival or disease-free survival [2]. Furthermore, it was noted that all the clinical data were from Japanese institutions, with patients mostly limited to those who had peripheral lesions <2 cm, and often with ground glass opacities.