Patient-reported outcomes after lobectomy vs. segmentectomy for early-stage non-small cell lung cancer.

Background: Surgical resection is the cornerstone for early-stage non-small cell lung cancer (NSCLC), with lobectomy historically standard. Evolving techniques have spurred debate comparing lobectomy and segmentectomy. This study analyzed early postoperative patient-reported symptoms and functional status in patients with early NSCLC undergoing either procedure.

Methods: This observational cohort study included 248 patients (Lobectomy = 92, Segmentectomy = 156) with early-stage NSCLC (tumor diameter ≤ 2 cm) who underwent uniport video-assisted thoracoscopic surgery (VATS), from December 2021 to December 2023. Patient-reported outcomes were collected using the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery scale at preoperative day 1, daily from postoperative days 1-4, and weekly for postoperative weeks 1-4. We compared early postoperative symptom/functional impairment scores, recovery time from moderate-to-severe symptoms, and short-term clinical outcomes.

Results: Both groups exhibited comparable early postoperative symptoms and functional status. No significant differences were observed between the two groups in any of the 7 symptom items or the 2 function items (all P > 0.05). The time to recovery from moderate-to-severe symptoms and functional impairment was also similar between the groups. Furthermore, there were no statistically significant differences in short-term clinical outcomes, including operative time, postoperative hospital stays, drainage time, discharge scores, or complication rates (all P > 0.05).

Conclusion: For early-stage NSCLC (tumor diameter ≤ 2 cm) undergoing uniport VATS, lobectomy and segmentectomy yield largely similar early postoperative symptom/functional burden, recovery times, and short-term outcomes. Considering external evidence on long-term oncology and function, segmentectomy is supported as a highly suitable option for this patient population.