Hot Topic In Thoracic Surgery: Can Sublobar Anatomical Resections Be Non-Inferior To Lobectomies For Small, Peripheral Non–Small-Cell Lung Cancer (NSCLC)? 9 Year Experience In A Single Center

Abstract

Background: Technological advances and widely spread screening programs enabled the discovery of ever smaller lesions. As such, in the last years, the tendency has shifted towards lung-sparing procedures. The role of limited surgical excision for small peripheral nodules is currently a topic of heated debate.

Aim: In our work, we try to answer whether the segmentectomy could adequately treat the peripheral NSCLC staged as Tis/1a-bN0M0.

Materials and methods: Our analysis is a single-center retrospective study based on the 8-year experience of our department. We identified 73 lobectomy patients and 16 segmentectomy patients. However, the lack of similarity between the two groups made it inadequate to draw satisfactory conclusions, therefore we reduced the lobectomy group and selected only those patients who could be paired with corresponding patients in the segmentectomy group. The established parameters of similarity were age (weighted at 15%), size of the lesion (50%), and follow-up (35%), and the input values were normalized. With this method, we could compare two samples of the most similar patients. 32 cases were included in the final analysis. The inclusion criteria were: NSCLC histology, size up to 2 cm, no visceral pleura invasion, N0 disease, and performed segmentectomy or lobectomy between Jan/2015 and Dec/2022. We analyzed the disease-free time and relapse rate.

Results: Data refers to a total of 32 patients distributed in two groups: group A with 16 segmentectomies (S6, S1+2 or S1) and group B with 16 lobectomies. The mean time of follow-up was 30 months (1-85) for group A and 32 months (1-91) for group B. The disease-free survival was 27 months for group A and 31 months for group B. The relapse rate was 19% for segmentectomies and 12.5% for lobectomies.

Conclusions: In conclusion, while this article presents our center's experience with segmentectomy, we believe further studies with larger sample sizes are needed to establish its non-inferiority. Nevertheless, our experience indicates that segmentectomy offers significant benefits, including lung preservation and the potential for future resections.