Purpose Segmentectomy is offered in selected patients with clinical T1a-b N0 M0 lung cancer. In case of positive N1 lymph node at fresh frozen section, conversion to lobectomy is recommended. Indication for redo surgery and completion lobectomy in case of positive N1 lymph node at final pathology is highly debated. We aim to compare the outcome between segmentectomy and lobectomy in patients with cT1a–b N0 M0 lung cancer with postoperative N1-upstaging. Methods We retrospectively reviewed all patients with pT1a-b N1cM0 lung cancer who underwent surgical resection with lymph node dissection between January 2013 and January 2024 at our institution. We included patients with tumor size ≤ 2 cm and postoperative N1-upstaging. Disease-free (DFS) and overall (OS) survivals were calculated from the date of surgery until recurrence or death and were compared between the groups. Results Twenty-five patients with cT1a-b N0 M0 lung cancer and postoperative N1-upstaging were identified. Median age was 64 years (42–81). Sixteen (64%) patients underwent lobectomy There was no significant difference in tumor size (median: 1,1, IQR<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\:[\)</EquationSource> </InlineEquation>1,1–1,8<InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\:]\)</EquationSource> </InlineEquation> vs. 1,5, IQR<InlineEquation ID="IEq3"> <EquationSource Format="TEX">\(\:[\)</EquationSource> </InlineEquation>1,4 − 1,8<InlineEquation ID="IEq4"> <EquationSource Format="TEX">\(\:]\)</EquationSource> </InlineEquation>, p = 0.186) and FEV1% (median: 76, IQR<InlineEquation ID="IEq5"> <EquationSource Format="TEX">\(\:[\)</EquationSource> </InlineEquation>74- 92<InlineEquation ID="IEq6"> <EquationSource Format="TEX">\(\:]\)</EquationSource> </InlineEquation> vs. 75, IQR<InlineEquation ID="IEq7"> <EquationSource Format="TEX">\(\:[\)</EquationSource> </InlineEquation>69- 87<InlineEquation ID="IEq8"> <EquationSource Format="TEX">\(\:]\)</EquationSource> </InlineEquation>, p = 0.656) between segmentectomy and lobectomy groups. Number of lymph nodes removed was significantly lower in the segmentectomy group (median: 10, IQR<InlineEquation ID="IEq9"> <EquationSource Format="TEX">\(\:[\)</EquationSource> </InlineEquation>4- 26<InlineEquation ID="IEq10"> <EquationSource Format="TEX">\(\:]\)</EquationSource> </InlineEquation> vs. 23, IQR<InlineEquation ID="IEq11"> <EquationSource Format="TEX">\(\:[\)</EquationSource> </InlineEquation>14- 32<InlineEquation ID="IEq12"> <EquationSource Format="TEX">\(\:]\)</EquationSource> </InlineEquation> p = 0.035). Median follow-up was 53, IQR<InlineEquation ID="IEq13"> <EquationSource Format="TEX">\(\:[\)</EquationSource> </InlineEquation>41- 63<InlineEquation ID="IEq14"> <EquationSource Format="TEX">\(\:]\)</EquationSource> </InlineEquation> months. There was no difference in 5-year DFS (72.9%vs 70.5%, p = 0.502) and OS (85,7%vs. 85,6%, p = 0.233) between the groups. Conclusion In patients who underwent segmentectomy or lobectomy for cT1a-b N0 M0 lung cancer and postoperative N1-upstaging, no difference in survivals was seen in our cohort.

Outcome of segmentectomy vs. lobectomy in patients with cT1a-b N0 lung cancer and postoperative N1 upstaging

期刊论文
出版模式：

开放获取
发表日期：

2026年5月30日

查看全文

Hafsa Kaman,
Theresa Stork,
Özlem Okumus,
Mehran Jemsi,
Ana-Maria Petrone,
Yazan Alnajdawi,
Stéphane Collaud

摘要

Purpose

Segmentectomy is offered in selected patients with clinical T1a-b N0 M0 lung cancer. In case of positive N1 lymph node at fresh frozen section, conversion to lobectomy is recommended. Indication for redo surgery and completion lobectomy in case of positive N1 lymph node at final pathology is highly debated. We aim to compare the outcome between segmentectomy and lobectomy in patients with cT1a–b N0 M0 lung cancer with postoperative N1-upstaging.

Methods

We retrospectively reviewed all patients with pT1a-b N1cM0 lung cancer who underwent surgical resection with lymph node dissection between January 2013 and January 2024 at our institution. We included patients with tumor size ≤ 2 cm and postoperative N1-upstaging. Disease-free (DFS) and overall (OS) survivals were calculated from the date of surgery until recurrence or death and were compared between the groups.

Results

Twenty-five patients with cT1a-b N0 M0 lung cancer and postoperative N1-upstaging were identified. Median age was 64 years (42–81). Sixteen (64%) patients underwent lobectomy There was no significant difference in tumor size (median: 1,1, IQR \(\:[\) 1,1–1,8 \(\:]\) vs. 1,5, IQR \(\:[\) 1,4 − 1,8 \(\:]\) , p = 0.186) and FEV1% (median: 76, IQR \(\:[\) 74- 92 \(\:]\) vs. 75, IQR \(\:[\) 69- 87 \(\:]\) , p = 0.656) between segmentectomy and lobectomy groups. Number of lymph nodes removed was significantly lower in the segmentectomy group (median: 10, IQR \(\:[\) 4- 26 \(\:]\) vs. 23, IQR \(\:[\) 14- 32 \(\:]\) p = 0.035). Median follow-up was 53, IQR \(\:[\) 41- 63 \(\:]\) months. There was no difference in 5-year DFS (72.9%vs 70.5%, p = 0.502) and OS (85,7%vs. 85,6%, p = 0.233) between the groups.

Conclusion

In patients who underwent segmentectomy or lobectomy for cT1a-b N0 M0 lung cancer and postoperative N1-upstaging, no difference in survivals was seen in our cohort.