Segmentectomy versus lobectomy for intersegmental small-sized non-small cell lung cancer.

OBJECTIVES

Intersegmental non-small cell lung cancer (NSCLC) represents a type of lesion involving at least two segments. This study aimed to demonstrate the characteristics of intersegmental NSCLC and compare the prognosis of segmentectomy with lobectomy for intersegmental NSCLC.

METHODS

A retrospective study was conducted on patients with small-sized NSCLC who underwent segmentectomy or lobectomy between January 2012 and December 2020. Intersegmental and non-intersegmental nodules were determined by three-dimensional computed tomographic bronchography and angiography. The log-rank test and Cox hazard proportional regression were adopted for prognostic analyses.

RESULTS

Totally, 1702 patients with 425 intersegmental nodules (25 %) and 1277 non-intersegmental nodules (75 %) were enrolled. Among eligible patients, 1086 patients accepted segmentectomy (intersegmental n = 188, non-intersegmental n = 898) and 616 patients underwent lobectomy (intersegmental n = 237, non-intersegmental n = 379). Intersegmental nodules were associated with larger tumor size and more lymph node metastasis (5.4 % vs. 2.1 %, P = 0.001), while intersegmental NSCLC achieved a similar prognosis to non-intersegmental NSCLC. Segmentectomy for intersegmental nodules required longer operative times, resection of more subsegments (4.06 vs. 2.91, P < 0.001), and larger resected lung volumes compared to that for non-intersegmental nodules. For patients with intersegmental nodules, the lobectomy group had larger tumor sizes, more solid nodules, and more lymph node metastasis than the segmentectomy group. After propensity score-matching, segmentectomy (n = 75) yielded comparable 5-year overall survival and disease-free survival with the lobectomy (n = 75).

CONCLUSION

Intersegmental nodules demonstrate a prognosis similar to non-intersegmental nodules, despite showing a higher rate of lymph node metastasis. Segmentectomy achieved long-term outcomes comparable to lobectomy for selected intersegmental NSCLC.