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Comparative Study
. 2024 Oct;54(10):1162-1172.
doi: 10.1007/s00595-024-02844-8. Epub 2024 Apr 18.

Clinical outcomes of left upper segmentectomy vs. lobectomy for early non-small-cell lung cancer: a nationwide database study in Japan

Shinya Tane  1 , Jiro Okami  2 , Yoshimasa Maniwa  3 , Yasushi Shintani  4 , Hiroyuki Ito  5 , Takashi Ohtsuka  6 , Shinichi Toyooka  7 , Takeshi Mori  8 , Shun-Ichi Watanabe  9 , Masayuki Chida  10 , Shunsuke Endo  11 , Ryoichi Nakanishi  12 , Mitsutaka Kadokura  13 , Hidemi Suzuki  14 , Etsuo Miyaoka  15 , Ichiro Yoshino  16 , Hiroshi Date  17 ; Japanese Joint Committee of Lung Cancer Registry
Affiliations
Comparative Study

Clinical outcomes of left upper segmentectomy vs. lobectomy for early non-small-cell lung cancer: a nationwide database study in Japan

Shinya Tane et al. Surg Today. 2024 Oct.

Abstract

Purpose: Given that left upper lobe and right upper and middle lobes share a similar anatomy, segmentectomy, such as upper division and lingulectomy, should yield identical oncological clearance to left upper lobectomy. We compared the prognosis of segmentectomy with that of lobectomy for early stage non-small-cell lung cancer (NSCLC) in the left upper lobe.

Methods: We retrospectively examined 2115 patients who underwent segmentectomy or lobectomy for c-stage I (TNM 8th edition) NSCLC in the left upper lobe in 2010. We compared the oncological outcomes of segmentectomy (n = 483) and lobectomy (n = 483) using a propensity score matching analysis.

Results: The 5-year recurrence-free and overall survival rates in the segmentectomy and lobectomy groups were comparable, irrespective of c-stage IA or IB. Subset analyses according to radiological tumor findings showed that segmentectomy yielded oncological outcomes comparable to those of lobectomy for non-pure solid tumors. In cases where the solid tumor exceeded 20 mm, segmentectomy showed a recurrence-free survival inferior to that of lobectomy (p = 0.028), despite an equivalent overall survival (p = 0.38).

Conclusion: Segmentectomy may be an acceptable alternative to lobectomy with regard to the overall survival of patients with c-stage I NSCLC in the left upper lobe.

Keywords: Left upper lobe; Non-small-cell lung cancer; Prognosis; Segmentectomy.

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Conflict of interest statement

The authors declare no conflicts of interest associated with this study.

Figures

Fig. 1
Fig. 1
Flowchart of study population selection
Fig. 2
Fig. 2
The recurrence-free and the overall survival of the overall cohort (A, D), c-stage IA (B, E), and c-stage IB (C, F) of the matched cohort
Fig. 3
Fig. 3
The recurrence-free survival of c-stage 0 (A), c-stage IA1 (B), c-stage IA2 (C) and c-stage IA3 (D) cases in the matched cohort
Fig. 4
Fig. 4
The overall survival of c-stage 0 (A), c-stage IA1 (B), c-stage IA2 (C), and c-stage IA3 (D) cases in the matched cohort
Fig. 5
Fig. 5
The recurrence-free and the overall survival of cases with a tumor diameter ≤ 20 mm corresponding to the following radiological findings: A, D GGO-dominant tumor (CTR ≤ 0.5), B, E solid-dominant tumor (CTR > 0.5 and < 1), and C, F pure solid tumor (CTR = 1). GGO, ground-glass opacity
Fig. 6
Fig. 6
The recurrence-free and the overall survival with tumor diameter > 20 mm corresponding to the following radiological findings: A, D GGO-dominant tumor (CTR ≤ 0.5), B, E solid-dominant tumor (CTR > 0.5 and < 1), and C, F pure solid tumor (CTR = 1). GGO, ground-glass opacity
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