Prognosis After Segmentectomy

By JCOG0802/WJOG4607L, large-scale randomized trial between segmentectomy vs. lobectomy was conducted for patients with stage IA (tumor diameter ≤ 2 cm; consolidation-to-tumor ratio > 0.5), of which results were published in 2022 [1]. Between 2009 and 2014, 1106 patients were enrolled to receive lobectomy (n = 554) or segmentectomy (n = 552). At a median follow-up of 7 years, the 5-year overall survival was 94.3% (92.1–96.0) for segmentectomy and 91.1% for lobectomy (95% CI 88.4–93.2); superiority and non-inferiority in overall survival were confirmed in segmentectomy group using a stratified Cox regression model (p < 0.0001 for non-inferiority; p = 0.0082 for superiority). At 1-year follow-up, the significant difference in the reduction of median forced expiratory volume in 1 s between the two groups was 3.5% (p < 0.0001). The 5-year relapse-free survival was 88.0% (95% CI 85.0–90.4) for segmentectomy and 87.9% (84.8–90.3) for lobectomy, of which difference was not significant (p = 0.9889). However, local relapse was 10.5% for segmentectomy, which was significantly higher than 5.4% for lobectomy (p = 0.0018). A 52 (63%) of 83 patients and 27 (47%) of 58 patients died of other diseases after lobectomy and segmentectomy, respectively. Postoperative complications of grade 2 or worse occurred at similar frequencies in both groups (26% in lobectomy vs. 27% in segmentectomy). The conclusion is that segmentectomy should be the standard surgical procedure for stage IA (tumor diameter ≤ 2 cm; consolidation-to-tumor ratio > 0.5).