Oncological Outcomes of Lobar Resection, Segmentectomy, and Wedge Resection for T1a Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-Analysis

The optimal treatment of early-stage non-small-cell lung cancer (NSCLC) remains subject to debate. Lobar resection is considered the standard of care, but sublobar resections are a lung parenchymal-sparing treatment offering promising results. We conducted a systematic review and meta-analysis to compare oncological outcomes of lobar resections and parenchymal-sparing resections for T1a NSCLC. PubMed, EMBASE, Web of Knowledge Search, and the Cochrane Central Register of Controlled Trials were searched for studies reporting oncological outcomes following lobar or parenchymal-sparing resections. Two researchers independently identified studies and extracted data. Oncological outcomes were compared for each surgical modality using the Mantel-Haenszel method, and outcomes were pooled for each modality using the inverse variance method. A total of 11,195 studies were identified and 28 articles were included. For pT1a tumors, there was no difference in 5-year overall survival when lobar resection (n = 15,003) was compared to parenchymal-sparing resection (n = 1224), with a relative risk of 0.92 (95% confidence interval: 0.84-1.01). Five-year overall survival and disease-free survival after segmentectomy yielded equal survival compared to lobar resection in directly comparing studies and point estimates of noncomparative studies. In most comparisons, wedge resection showed comparable results to lobar resections and segmentectomy. Subanalysis of intentional parenchymal-sparing surgery showed favorable results. This study shows that parenchymal-sparing surgery yields equivocal survival compared to lobar surgery for stage T1a NSCLC. However, a drawback in implementing parenchymal-sparing resection for lobectomy-tolerable patients is the risk of nodal upstaging.