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Introduction <p>Lobectomy is the standard surgical approach for early-stage non-small cell lung cancer (NSCLC), while segmentectomy has gained increasing attention as a parenchyma-sparing alternative. Recent randomized prospective trials have demonstrated comparable survival outcomes between the two procedures in patients with peripherally located, node-negative NSCLC ≤ 2&#xa0;cm. This study aimed to compare survival outcomes between segmentectomy and lobectomy in patients with T1N0 NSCLC.</p> Methods <p>We conducted a retrospective, multicenter study using data from six thoracic surgery clinics across Türkiye. Initially, 317 patients who underwent segmentectomy and 252 who underwent lobectomy were identified. After 1:1 propensity score matching with a 20% tolerance for demographic differences, 223 patients from each group were included. The groups were compared in terms of clinical, pathological, and survival characteristics.</p> Results <p>After matching, baseline characteristics were well-balanced. The segmentectomy group had a significantly higher rate of VATS procedures and adenocarcinoma histology (both <i>p</i> &lt; 0.001). In contrast, the lobectomy group had larger tumors and higher rates of pleural, perineural, lymphatic, and vascular invasion, as well as STAS (<i>p</i> &lt; 0.001, <i>p</i> &lt; 0.001, <i>p</i> &lt; 0.001, <i>p</i> &lt; 0.001, and <i>p</i> = 0.02 respectively). Segmentectomy was associated with a shorter hospital stay and fewer pulmonary complications (<i>p</i> &lt; 0.001 and <i>p</i> = 0.002, respectively). Although median survival was longer in the segmentectomy group, the difference was not statistically significant (<i>p</i> = 0.062). Non-adenocarcinoma histology and vascular invasion were identified as independent predictors of poor prognosis (<i>p</i> &lt; 0.001 and <i>p</i> = 0.017, respectively).</p> Conclusions <p>Segmentectomy offers comparable survival to lobectomy in T1N0 NSCLC while providing perioperative advantages. Histological subtype and vascular invasion remain important prognostic factors, necessitating close monitoring in high-risk patients.</p> Graphical abstract <p></p>

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Segmentectomy or Lobectomy in T1N0M0 Non-Small Cell Lung Carcinomas: The Prognostic Role of Histology and Vascular Invasion

  • 期刊论文

  • 发表日期：

    2026年4月4日

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  • Gizem Özçıbık Işık,
  • Akif Turna,
  • Serhan Tanju,
  • Celal Buğra Sezen,
  • Hasan Volkan Kara,
  • Hüseyin Melek,
  • Ali Çelik,
  • Muhammet Sayan,
  • Mustafa Vedat Doğru,
  • Suat Erus,
  • Cengiz Gebitekin,
  • Yekta Altemur Karamustafaoğlu,
  • Kadir Burak Özer,
  • Şükrü Dilege

摘要

Introduction

Lobectomy is the standard surgical approach for early-stage non-small cell lung cancer (NSCLC), while segmentectomy has gained increasing attention as a parenchyma-sparing alternative. Recent randomized prospective trials have demonstrated comparable survival outcomes between the two procedures in patients with peripherally located, node-negative NSCLC ≤ 2 cm. This study aimed to compare survival outcomes between segmentectomy and lobectomy in patients with T1N0 NSCLC.

Methods

We conducted a retrospective, multicenter study using data from six thoracic surgery clinics across Türkiye. Initially, 317 patients who underwent segmentectomy and 252 who underwent lobectomy were identified. After 1:1 propensity score matching with a 20% tolerance for demographic differences, 223 patients from each group were included. The groups were compared in terms of clinical, pathological, and survival characteristics.

Results

After matching, baseline characteristics were well-balanced. The segmentectomy group had a significantly higher rate of VATS procedures and adenocarcinoma histology (both p < 0.001). In contrast, the lobectomy group had larger tumors and higher rates of pleural, perineural, lymphatic, and vascular invasion, as well as STAS (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.02 respectively). Segmentectomy was associated with a shorter hospital stay and fewer pulmonary complications (p < 0.001 and p = 0.002, respectively). Although median survival was longer in the segmentectomy group, the difference was not statistically significant (p = 0.062). Non-adenocarcinoma histology and vascular invasion were identified as independent predictors of poor prognosis (p < 0.001 and p = 0.017, respectively).

Conclusions

Segmentectomy offers comparable survival to lobectomy in T1N0 NSCLC while providing perioperative advantages. Histological subtype and vascular invasion remain important prognostic factors, necessitating close monitoring in high-risk patients.

Graphical abstract