Clinical outcomes of left upper segmentectomy vs. lobectomy for early non-small-cell lung cancer: a nationwide database study in Japan

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2024年4月18日

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Shinya Tane,
Jiro Okami,
Yoshimasa Maniwa,
Yasushi Shintani,
Hiroyuki Ito,
Takashi Ohtsuka,
Shinichi Toyooka,
Takeshi Mori,
Shun-ichi Watanabe,
Masayuki Chida,
Shunsuke Endo,
Ryoichi Nakanishi,
Mitsutaka Kadokura,
Hidemi Suzuki,
Etsuo Miyaoka,
Ichiro Yoshino,
Hiroshi Date

摘要

Purpose

Given that left upper lobe and right upper and middle lobes share a similar anatomy, segmentectomy, such as upper division and lingulectomy, should yield identical oncological clearance to left upper lobectomy. We compared the prognosis of segmentectomy with that of lobectomy for early stage non-small-cell lung cancer (NSCLC) in the left upper lobe.

Methods

We retrospectively examined 2115 patients who underwent segmentectomy or lobectomy for c-stage I (TNM 8th edition) NSCLC in the left upper lobe in 2010. We compared the oncological outcomes of segmentectomy (n = 483) and lobectomy (n = 483) using a propensity score matching analysis.

Results

The 5-year recurrence-free and overall survival rates in the segmentectomy and lobectomy groups were comparable, irrespective of c-stage IA or IB. Subset analyses according to radiological tumor findings showed that segmentectomy yielded oncological outcomes comparable to those of lobectomy for non-pure solid tumors. In cases where the solid tumor exceeded 20 mm, segmentectomy showed a recurrence-free survival inferior to that of lobectomy (p = 0.028), despite an equivalent overall survival (p = 0.38).

Conclusion

Segmentectomy may be an acceptable alternative to lobectomy with regard to the overall survival of patients with c-stage I NSCLC in the left upper lobe.