Comparison of cancer control between segmentectomy and wedge resection in patients with clinical stage IA non-small cell lung cancer

J Thorac Cardiovasc Surg. 2021 Oct;162(4):1244-1252.e1. doi: 10.1016/j.jtcvs.2020.10.024. Epub 2020 Oct 22.

Abstract

Objective: The study objective was to compare cancer control between segmentectomy and wedge resection in patients with clinical stage IA non-small cell lung cancer.

Methods: Between 2010 and 2015, 457 patients with clinical stage IA (8th edition) non-small cell lung cancer undergoing wedge resection or segmentectomy were identified at 3 institutions. Propensity scores were calculated on the basis of the extent of resection (wedge resection or segmentectomy) and included adjustment for confounding variables, such as age, sex, smoking status, pulmonary functions, laterality, tumor size, maximum standardized uptake value on 18F-fluorodeoxyglucose positron emission tomography, presence of ground-glass opacity on high-resolution computed tomography, histology, and visceral pleural invasion for multivariable analysis and matching. The primary end point was cumulative incidence of recurrence.

Results: In all cohorts, postoperative recurrence occurred in 36 of 195 patients (18.5%) undergoing wedge resection and 14 of 262 patients (5.3%) undergoing segmentectomy. Cumulative incidence of recurrence was significantly lower in patients undergoing segmentectomy (5-year cumulative incidence of recurrence, 5.3%) than in those undergoing wedge resection (5-year cumulative incidence of recurrence, 19.1%; P < .001). In propensity score-adjusted multivariable analysis, segmentectomy was identified as an independent favorable prognostic factor for cumulative incidence of recurrence (hazard ratio, 0.47; 95% confidence interval, 0.24-0.90; P = .022). In propensity score matching of 163 pairs, cumulative incidence of recurrence was significantly lower in patients undergoing segmentectomy (5-year cumulative incidence of recurrence, 6.6%) than in those undergoing wedge resection (5-year cumulative incidence of recurrence, 13.2%; P = .041).

Conclusions: Cancer control was better in segmentectomy than in wedge resection. Segmentectomy is the preferred oncologic procedure as sublobar resection to treat clinical stage IA non-small cell lung cancer.

Keywords: non–small cell lung cancer; recurrence; segmentectomy; sublobar resection; wedge resection.

MeSH terms

  • Aged
  • Carcinoma, Non-Small-Cell Lung* / epidemiology
  • Carcinoma, Non-Small-Cell Lung* / pathology
  • Carcinoma, Non-Small-Cell Lung* / surgery
  • Female
  • Humans
  • Incidence
  • Japan / epidemiology
  • Lung Neoplasms* / epidemiology
  • Lung Neoplasms* / pathology
  • Lung Neoplasms* / surgery
  • Lung* / diagnostic imaging
  • Lung* / pathology
  • Lung* / surgery
  • Male
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local* / diagnosis
  • Neoplasm Recurrence, Local* / epidemiology
  • Neoplasm Staging
  • Pneumonectomy* / adverse effects
  • Pneumonectomy* / methods
  • Positron-Emission Tomography / methods
  • Prognosis
  • Propensity Score
  • Risk Assessment / methods
  • Risk Factors
  • Tomography, X-Ray Computed / methods