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Anatomic Segmentectomy for Stage I Non-Small Cell Lung Cancer (NSCLC): Outcomes Comparison of Individual Segmental Resections vs. Corresponding Lobectomy
M. J. Schuchert, B. L. Pettiford, A. Kilic, A. Pennathur, G. Abbas, O. Awais, R. Jack, J. R. Landreneau, J. P. Landreneau, J. D. Luketich, R. J. Landreneau. Heart, Lung and Esophageal Surgery Institute; University of Pittsburgh Medical Center, Pittsburgh, PA,
BACKGROUND:
Anatomic segmentectomy is increasingly being considered as a means of achieving an R0 resection for small, peripheral stage I NSCLC. This approach has been slow to gain widespread use due to perceived technical complexity and concerns regarding oncologic efficacy. To date, there is little data regarding the outcomes of individual anatomic segmental resections vs. lobectomy. In the current study, we compare the perioperative outcomes and recurrence patterns of individual anatomic segmental resections with the corresponding lobectomy for Stage I NSCLC.
METHODS:
A total of 222 consecutive anatomic segmentectomies were performed for Stage IA (n=136) or IB (n=86) NSCLC from 2002-2007. Lobectomy was performed in 343 patients for Stage IA (n=160) and IB (n=183) during the same period. Results of segmental resection were compared with the outcomes of the corresponding lobectomy. Primary outcome variables included hospital course, complications, mortality and recurrence patterns. Statistical analysis included paired and one-sample t-tests. The probability of overall and recurrence-free survival was estimated with the Kaplan-Meier method, with significance being estimated by the log rank test.
RESULTS:
Mean age (69.8 vs. 67.9 years), gender distribution and tumor histology were similar between the segmentectomy and lobectomy groups. Average tumor size was larger in the lobectomy group (3.0 cm) compared with segments (2.3cm) [p<0.001]. Mean follow-up was 20.7 months for segments and 25.9 months for lobes. Overall mortality for segmentectomy was 0.9%, compared with lobectomy (3.2%). Overall recurrence rates were similar between the groups (Segmentectomy=17.6%; Lobectomy=18.1%). Each segmental resection was associated with decreased operative time when compared to the corresponding lobectomy. There were no significant differences in length of stay, morbidity patterns, operative mortality or recurrence rates when comparing individual segmental approaches with the corresponding lobar resection.
CONCLUSIONS:
Anatomic segmentectomy can be performed safely with acceptable perioperative course, morbidity, mortality and recurrence rates. All segmental approaches can be performed with outcomes similar to the corresponding lobectomy. The potential benefits of segmentectomy vs. lobectomy will need to be further evaluated by prospective, randomized trials (ACOSOG Z4032; CALGB-Altorki study).
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