Reply to Zhou et al.

Abstract

We would like to thank Zhou et al. [1] for their interest in our article. Our study compared the prognosis between segmentectomy and lobectomy for non-small-cell lung cancer (NSCLC) with lymphatic invasion, vascular invasion, pleural invasion or pathological lymph node metastasis [2]. We included lymphatic invasion and vascular invasion because they were significant prognostic factors for early-stage NSCLC, which were comparable to pleural invasion in other studies [3]. As mentioned in their letter, it is difficult to directly adapt the results to the selection of a surgical procedure. Moreover, there were no data regarding whether segmentectomy was performed with curative or compromised intent. This could explain the difference in the number of resected lymph nodes and patients who received adjuvant therapy. The incidence of pathological lymph node metastasis would probably be higher in patients with larger tumours. However, the number of patients with pure solid tumours and the incidence of lymph node metastasis were high in our study. In the JCOG0802/WJOG4607L trial, the median tumour size was larger than 15 mm, with no subgroups showing favourable prognosis after lobectomy [4]. This suggests that segmentectomy can be feasible for early-stage NSCLC with a relatively higher risk of recurrence. Although an intraoperative diagnosis of lymph node metastasis may necessitate lobectomy, not all tumours larger than 15 mm may require initial lobectomy.