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Review
. 2025 Jun 19;14(12):4385.
doi: 10.3390/jcm14124385.

Recurrence Pattern of Left Upper Lobectomies and Trisegmentectomies: Systematic Review and Meta-Analysis

Borja Aguinagalde  1   2   3 , Juan A Ferrer-Bonsoms  4 , Iker López  1   3 , Jon Ander Lizarbe  1   3 , Arantza Fernandez-Monge  1   3 , Maria Mainer  1   3 , Raul Embun  5 , Jon Zabaleta  1   3
Affiliations
Review

Recurrence Pattern of Left Upper Lobectomies and Trisegmentectomies: Systematic Review and Meta-Analysis

Borja Aguinagalde et al. J Clin Med. .

Abstract

Background: Surgical resection remains the standard treatment for early-stage non-small-cell lung cancer (NSCLC). Traditionally, lobectomy has been considered the procedure of choice; however, emerging evidence suggests that trisegmentectomy may offer comparable outcomes. This meta-analysis evaluates whether left upper lobe trisegmentectomy provides non-inferior or superior oncologic outcomes compared to left upper lobectomy, with particular attention to recurrence patterns. Methods: Following PRISMA guidelines, we included comparative studies evaluating left upper lobectomy versus trisegmentectomy. Outcomes assessed included recurrence (locoregional and distant), morbidity, and the length of hospital stay. A meta-analysis was conducted using the metabin function from the R meta package. Results: Of 14 identified articles, 9 met the inclusion criteria. No significant differences were observed in locoregional recurrence. However, distant recurrence was significantly lower in the trisegmentectomy group (OR 0.58; 95% CI 0.41-0.82). While overall morbidity showed no significant difference (OR 0.95), analysis of matched studies favored trisegmentectomy (OR 0.73; 95% CI 0.56-0.96). Hospital stay was significantly shorter in the trisegmentectomy group (OR -0.94; 95% CI -1.26 to -0.63). Conclusions: Trisegmentectomy and lobectomy exhibit distinct recurrence patterns, with lobectomy associated with a higher rate of distant recurrence. Trisegmentectomy may provide oncologic and perioperative advantages in appropriately selected patients. The systematic review and meta-analysis are registered in PROSPERO (registration number: CRD420251066445).

Keywords: lobectomy; lung cancer; sublobar resection; systematic review; trisegmentectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Search strategy formulation (with keywords and Boolean operators).
Figure 2
Figure 2
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart.
Figure 3
Figure 3
A locorregional recurrence forest plot ((A) all studies and (B) matched studies) [2,3,4,5,6,8,9,10,11].
Figure 4
Figure 4
A distant recurrence forest plot ((A) all studies and (B) matched studies) [2,3,4,5,6,8,9,10,11].
Figure 5
Figure 5
An overall recurrence forest plot ((A) all studies and (B) matched studies) [2,3,4,5,6,8,9,10,11].
Figure 6
Figure 6
A morbidity forest plot ((A) all studies and (B) matched studies) [2,3,4,5,6,8,9,10,11].
Figure 7
Figure 7
The length of stay forest plot ((A) all studies and (B) matched studies) [2,3,4,5,6,8,9,10,11].
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