Segmentectomy vs Lobectomy for Non-Small Cell Lung Cancer: The Impact of Tumor Location

Lye-Yeng Wong; Ntemena Kapula; Irmina A Elliott; Douglas Z Liou; Leah M Backhus; Natalie S Lui; Joseph B Shrager; Mark F Berry

doi:10.1016/j.atssr.2024.01.014

Segmentectomy vs Lobectomy for Non-Small Cell Lung Cancer: The Impact of Tumor Location

Ann Thorac Surg Short Rep. 2024 Feb 22;2(3):458-463. doi: 10.1016/j.atssr.2024.01.014. eCollection 2024 Sep.

Authors

Lye-Yeng Wong¹, Ntemena Kapula¹, Irmina A Elliott¹, Douglas Z Liou¹, Leah M Backhus^{1

2}, Natalie S Lui¹, Joseph B Shrager^{1

2}, Mark F Berry^{1

2}

Affiliations

¹ Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
² Department of Cardiothoracic Surgery, VA Palo Alto Health Care System, Palo Alto, California.

Abstract

Background: The technical complexity of segmentectomy and preservation of lung parenchyma compared with lobectomy vary by lobe. This study evaluated the impact of non-small cell lung cancer tumor location on segmentectomy use and outcomes.

Methods: Outcomes after lobectomy or segmentectomy for cT1N0M0 (≤2 cm) non-small cell lung cancer patients stratified by tumor location in smaller (right upper/middle) vs larger (bilateral lower/left upper) lobes were evaluated with logistic regression, Kaplan-Meier curves, and Cox proportional hazards methods.

Results: A minority of patients in the cohort (N = 31,243) underwent segmentectomy (n = 2783, 9%). Segmentectomy was more common for tumors in larger compared with smaller lobes (11.8% vs 5.1%, P < .001). Major morbidity after segmentectomy was significantly lower than lobectomy for both smaller (2.6% vs 5.7%, odds ratio, 0.41, P < .001) and larger (2.5% vs 5.2%, odds ratio, 0.46, P < .001) lobes. Segmentectomy was associated with smaller lymph node harvest for both types of lobes (small lobes 7.0 vs 10.5, P < .001; large lobes 7.5 vs 10.4, P < .001) but did not compromise survival in multivariate analysis for both small (hazard ratio, 0.99, P = .9) and large (hazard ratio, 1.05, P = .34) lobes.

Conclusions: Segmentectomy that does not compromise oncologic principles should be considered if complete resection is feasible regardless of tumor location.