Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer

Background: Thoracoscopic lobectomy for lung cancer has been widely accepted, but thoracoscopic segmentectomy remains controversial because of the complexity of the procedure and of the fear of increased local recurrence. This study compared outcomes between thoracoscopic segmentectomy and thoracoscopic lobectomy in patients with small-sized (≤2 cm) stage IA non-small cell lung cancer.

Methods: Between March 2006 and August 2011, 39 thoracoscopic segmentectomies and 81 thoracoscopic lobectomies were performed in 120 patients with small-sized (≤2 cm) stage IA lung cancer. Clinicopathologic factors, local recurrence rate, and survival rate were compared.

Results: The two groups were similar in age, sex, pulmonary function, and tumor size. There were no conversions from video-assisted thoracoscopic surgery to open or from segmentectomy to lobectomy. There were no in-hospital deaths. The two groups had a similar incidence of postoperative complications. Local recurrence rates were similar after thoracoscopic segmentectomy (5.1%) and thoracoscopic lobectomy (4.9%). No significant difference was observed in 5-year overall or disease-free survivals after thoracoscopic segmentectomy or thoracoscopic lobectomy. Multivariate Cox regression analyses showed tumor size was the only independent prognostic factor for disease-free survival.

Conclusions: Thoracoscopic segmentectomy is a safe option and provides comparable oncologic results to thoracoscopic lobectomy for small (≤2 cm) peripheral stage IA non-small cell lung cancer. Tumor size is an independent prognostic factor of disease-free survival for stage IA patients with small-sized lesions.