Oncologic outcomes of three-dimensional navigation-guided segmentectomy for early-stage non-small cell lung cancer >2-3 cm.

Background: The outcomes of segmentectomy for small (≤2 cm) non-small cell lung cancer (NSCLC) have been well demonstrated. This study aimed to investigate whether segmentectomy could achieve comparable oncologic outcomes with lobectomy for >2-3 cm lung cancer.

Methods: Patients who underwent segmentectomy or lobectomy for NSCLC >2-3 cm were retrospectively screened. Segmentectomy was performed under the guidance of three-dimensional computed tomographic bronchography and angiography (3D-CTBA). The log-rank test, Cox hazard proportional regression, and propensity score matching analyses were adopted for prognostic evaluation.

Results: Among the 430 eligible patients, segmentectomy and lobectomy were performed for 103 and 327 patients, respectively. The median follow-up time was 60.2 months. No postoperative 90-day mortality occurred. There was no significant difference in postoperative complication (grade ≥2) between lobectomy and segmentectomy (19.3 % vs 16.5 %, P = 0.629). At 1 year or longer postoperatively, the difference in the median FEV1 and FVC reduction between the two groups was 2.3 % (P < 0.001) and 2.4 % (P = 0.028), respectively. The proportion of locoregional recurrence was 1.9 % after segmentectomy and 1.8 % after lobectomy. After propensity score matching, segmentectomy (n = 87) conferred a similar prognosis as lobectomy (5-year DFS: 89.1 % vs. 91.8 %; 5-year OS: 93.3 % vs. 93.0 %). Further subgroup analyses showed that segmentectomy achieved comparable long-term outcomes to lobectomy even for pure solid tumors (DFS: P = 0.850; OS: P = 0.720) or for tumors with a solid component size >2 cm (DFS: P = 0.640; OS: P = 0.800).

Conclusion: The 3D-CTBA guided segmentectomy could achieve equivalent long-term outcomes to lobectomy for selected cT1N0M0 NSCLC with a tumor size >2 but ≤3 cm.