Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stage IA non-small cell lung cancer: a propensity score matching study

Background: Segmentectomy for lung cancer remains controversial because of the complexity of the procedure and concern about an increased recurrence rate. It is important to compare perioperative and oncological outcomes between segmentectomy and lobectomy.

Methods: From January 2007 to December 2016, 41 segmentectomies by video-assisted thoracic surgery (VATS) and 122 VATS lobectomies for 163 patients with clinical stage IA non-small cell lung cancer (NSCLC) were performed. Clinicopathological factors, including recurrence rate and survival rate, were compared. In order to reduce biases of outcomes, clinicopathological factors were used for propensity score matching (PSM). Then, 41 VATS segmentectomies and 41 lobectomies were selected and further analyzed.

Results: No significant differences were seen between the two groups in age, pulmonary function, comorbidity, operative time, blood loss, chest tube duration days, postoperative stay days, complications, histological type, and multiple primary rate. Smoking index resected number of nodes, tumor size, lymph node metastasis rate, and pathological stage were higher in the lobectomy group than in the segmentectomy group (P<0.05). In the lobectomy group, 16 patients (13.1%) had recurrence, and 2 patients (1.6%) died because of cancer progression. There were no significant differences in the recurrence rate and prognosis between the two groups. In addition, Cox regression analysis suggested that sex, lymph node metastasis, and pathology stage were associated with recurrence (P<0.05), but no factor was an independent prognostic factor. After PSM, the two groups had similar clinicopathological factors, and the type of operation still had no relationship with the recurrence rate or the death rate.

Conclusions: Perioperative and oncological outcomes of VATS segmentectomy are similar to those of VATS lobectomy for patients with clinical stage IA NSCLC. VATS segmentectomy can be considered one of the surgical procedures appropriate for patients with clinical stage IA NSCLC.