Complete anatomic segmentectomy shows improved oncologic outcomes compared to incomplete anatomic segmentectomy
Miles A McAllister, Matthew M Rochefort, Paula Ugalde Figueroa, Rachel Leo, Evert A Sugarbaker, Anupama Singh, Julio Herrera-Zamora, Rafael R Barcelos, Emanuele Mazzola, Hillary Heiling, Michael T Jaklitsch, Raphael Bueno, Scott J Swanson- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine
- General Medicine
- Surgery
Abstract
OBJECTIVE
To compare oncologic outcomes after segmentectomy with division of segmental bronchus, artery, and vein (complete anatomic segmentectomy) versus segmentectomy with division of < 3 segmental structures (incomplete anatomic segmentectomy).
METHODS
We conducted a single-center, retrospective analysis of patients undergoing segmentectomy from 03/2005-05/2020. Operative reports were audited to classify procedures as complete or incomplete anatomic segmentectomy. Patients who underwent neoadjuvant therapy or pulmonary resection beyond indicated segments were excluded. Survival was estimated with Kaplan-Meier models and compared using log-rank tests. Cox proportional hazards models were used to estimate hazard ratios for death. Cumulative incidence functions for locoregional recurrence were compared with Gray’s test, with death considered a competing event. Cox and Fine-Gray models were used to estimate cause-specific and subdistribution hazard ratios, respectively, for locoregional recurrence.
RESULTS
Of 390 cases, 266 (68.2%) were complete and 124 were incomplete anatomic segmentectomy. Demographics, pulmonary function, tumor size, stage, and perioperative outcomes did not significantly differ between groups. Surgical margins were negative in all but one case. Complete anatomic segmentectomy was associated with improved lymph node dissection (5 vs. 2 median nodes sampled; p<0.001). Multivariable analysis revealed reduced incidence of locoregional recurrence (CSHR=0.42; 95% CI 0.22-0.80; SDHR=0.43; 95% CI 0.23-0.81), and non-significant improvement in overall survival (HR = 0.66; 95% CI: 0.43-1.00) after complete vs. incomplete anatomic segmentectomy.
CONCLUSIONS
This single-center experience suggests complete anatomic segmentectomy provides superior locoregional control and may improve survival relative to incomplete anatomic segmentectomy. We recommend surgeons perform complete anatomic segmentectomy and lymph node dissection whenever possible.