Role of Pulmonary Segmentectomy in Stage IB Non-Small Cell Lung Cancer ≤ 3 cm with Visceral Pleural Invasion: A Single-Centre Retrospective Study
Edoardo Zanfrini, Samuele Tossut, Ye Tian, Etienne Abdelnour-Berchtold, Matthieu Zellweger, Alban Lovis, Jean Yannis Perentes, Thorsten Krueger, Michel GonzalezAbstract
Objectives
We evaluated oncological outcomes of anatomical segmentectomy vs. lobectomy in patients with non-small cell lung cancer (NSCLC) ≤ 3 cm with visceral pleural invasion (VPI).
Methods
We retrospectively analyzed consecutive patients undergoing anatomical pulmonary resection with systematic mediastinal lymph node dissection for pT2aN0M0 (stage IB) NSCLC with VPI between January 2014 and December 2023 at a single center. To account for baseline differences in treatment allocation, propensity-score overlap weighting was performed, and weighted Cox proportional-hazards models were used to compare overall survival (OS) and recurrence-free survival (RFS).
Results
Ninety-two patients (male 48, female 44; median age: 70 years, IQR: 62–77) underwent anatomical resection (lobectomy n = 48; segmentectomy n = 44) for NSCLC stage IB with VPI. VATS was performed in 94.6% of cases. Segmentectomy group had more comorbidities and poorer pre-operative pulmonary function. Complete resection was achieved in all patients. After overlap weighting, baseline characteristics included in the propensity model were well balanced. No statistically significant difference was observed between segmentectomy and lobectomy for OS (HR 0.89, 95% CI 0.33–2.39; p = 0.809) or RFS (HR 0.85 (0.0.36–1.98), p = 0.701). Three-year overlap-weighted OS was 75.3% after segmentectomy and 72.2% after lobectomy; corresponding RFS estimates were 63.8% and 57.9%, respectively. Perioperative outcomes were broadly similar after weighting, although prolonged air leak was less frequent after segmentectomy.
Conclusions
After adjustment for measured baseline differences, segmentectomy was not associated with a statistically significant difference in intermediate-term OS or RFS compared with lobectomy in this selected VPI-positive cohort. These findings support further evaluation of segmentectomy in carefully selected VPI-positive patients.