Comparison of oncological outcomes between wedge resection and segmentectomy for T1a/bN0M0 non-small-cell lung cancer: a population-based retrospective cohort study.

Background: Sublobar resection, including wedge resection (WR) and segmental resection (SR) has been considered for early-stage non-small-cell lung cancer (NSCLC). However, the optimal sublobar approach continues to be a subject of extensive debate within the thoracic surgical community. This study aimed to compare the oncological outcomes of WR and SR in such patients.

Methods: T1a/bN0M0 NSCLC patients who underwent WR or SR between 2000 and 2019 were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was employed to establish a balanced cohort, and overall survival (OS) and cancer-specific survival (CSS) were statistically analyzed.

Results: A total of 4112 patients were included, with 3283 (79.8%) in the WR group and 829 (20.2%) in the SR group. Following 1:1 PSM, 764 patients in each group were further evaluated. The SR group exhibited significantly longer OS (P < 0.001) and CSS (P = 0.032) compared to the WR group. Multivariate Cox regression analysis revealed that SR was independently associated with improved survival outcomes (P < 0.001, hazard ratio [HR] = 0.78, 95% confidence interval [CI]: 0.68-0.90 for OS; P = 0.036, HR = 0.80, 95% CI: 0.65-0.99 for CSS). Additionally, variables such as sex, race, tumor grade, and histological type were identified as independent factors predictive of both OS and CSS. In subgroup analysis adjusted for all covariates, patients with tumors measuring 1-2 cm demonstrated a significant association between SR and improved OS and CSS.

Conclusion: Segmentectomy provided superior oncological outcomes for NSCLC ≤ 2 cm in the overall cohort, whereas there were no significant differences in OS and CSS between the two sublobar procedures for tumors of 0-1 cm. WR may be a reasonable option for 0-1 cm tumors in select cases, particularly for peripheral lesions.