Oncological Outcomes of Segmentectomy versus Lobectomy in Clinical Stage I Non-Small Cell Lung Cancer up to Two Centimeters: Systematic Review and Meta-Analysis

Ilaria Righi; Sebastiano Maiorca; Cristina Diotti; Gianluca Bonitta; Paolo Mendogni; Davide Tosi; Mario Nosotti; Lorenzo Rosso

doi:10.3390/life13040947

Oncological Outcomes of Segmentectomy versus Lobectomy in Clinical Stage I Non-Small Cell Lung Cancer up to Two Centimeters: Systematic Review and Meta-Analysis

Life (Basel). 2023 Apr 4;13(4):947. doi: 10.3390/life13040947.

Authors

Ilaria Righi¹, Sebastiano Maiorca², Cristina Diotti³, Gianluca Bonitta², Paolo Mendogni¹, Davide Tosi¹, Mario Nosotti^{1

2}, Lorenzo Rosso^{1

2}

Affiliations

¹ Department of Cardio-Thoracic and Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
² Department of Patho-Physiology and Transplantation, University of Milan, 20122 Milan, Italy.
³ Department of Thoracic Surgery, European Institute of Oncology, 20141 Milan, Italy.

Abstract

Objective: In recent years, pulmonary segmentectomy has emerged as an alternative to lobectomy for the treatment of patients with clinical stage I non-small cell lung cancer. Considering the conflicting results reported in the literature, the oncological effectiveness of segmentectomy remains controversial. To provide new insight into oncological results, we reviewed the literature, including recent randomized trials.

Methods: We performed a systematic review for surgical treatment of stage I NSCLC up to 2 cm using MEDLINE and the Cochrane Database from 1990 to December 2022. Primary outcomes for pooled analysis were overall and disease-free survival; secondary outcomes were postoperative complications and 30-day mortality.

Results: Eleven studies were considered for the meta-analysis. The pooled analysis included 3074 and 2278 patients who received lobectomy and segmentectomy, respectively. The estimated pooled hazard ratio showed a similar hazard for segmentectomy compared to lobectomy in terms of overall and disease-free survival. The restricted mean survival time difference between the two procedures was statistically and clinically not significant for overall and disease-free survival. Nevertheless, the overall survival hazard ratio was time-dependent: segmentectomy was at a disadvantage starting from 40 months after surgery. Six papers reported 30-day mortality: there were no events on 1766 procedures. The overall relative risk showed that the postoperative complication rate was higher in segmentectomy compared to lobectomy, without statistical significance.

Conclusions: Our results suggest that segmentectomy might be a useful alternative to lobectomy for stage I NSCLC up to 2 cm. However, this appears to be time-dependent; in fact, the risk ratio for overall mortality becomes unfavorable for segmentectomy starting at 40 months after surgery. This last observation, together with some still undefined questions (solid/non-solid ratio, depth of the lesion, modest functional savings, etc.), leave room for further investigations on the real oncological effectiveness of segmentectomy.

Keywords: lobectomy; lung cancer; lung neoplasms; segmentectomy; surgery.

Publication types

Review

Grants and funding

The publication costs were supported by a research fund of the Italian Ministry of Health donated to the IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico.