Segmentectomy versus Lobectomy for Non-Small Cell Lung Cancer: The Impact of Tumor Location

BACKGROUND The technical complexity of segmentectomy and preservation of lung parenchyma compared to lobectomy vary by lobe. This study evaluated the impact of non-small cell lung cancer (NSCLC) tumor location on segmentectomy use and outcomes. METHODS Outcomes after lobectomy or segmentectomy for cT1N0M0 (< 2 cm) NSCLC patients stratified by tumor location in smaller (right upper/middle) versus larger (bilateral lower/left upper) lobes were evaluated with logistic regression, Kaplan-Meier curves, and Cox proportional hazards methods. RESULTS A minority of patients in the cohort (n=31,243) underwent segmentectomy (n=2,783, 9%). Segmentectomy was more common for tumors in larger compared to smaller lobes (11.8% versus 5.1%,p<0.001). Major morbidity after segmentectomy was significantly lower than lobectomy for both smaller (2.6% vs 5.7%[p<0.001],OR 0.41,p<0001) and larger (2.5% vs 5.2%[p<0.001],OR 0.46,p<0.001) lobes. Segmentectomy was associated with smaller lymph node harvest for both types of lobes (small lobes 7.0 vs 10.5,p<0.001; large lobes 7.5 vs 10.4,p<0.001) but did not compromise survival in multivariate analysis for both small (HR 0.99,p=0.9) and large (HR 1.05,p=0.34) lobes. CONCLUSIONS Segmentectomy that does not compromise oncologic principles should be considered if complete resection is feasible regardless of tumor location.