Minimally invasive segmentectomy and lobectomy for peripheral stage IA1-2 NSCLC: a case matched cohort study from a UK centre

Abstract Objective The objective of this study is to compare in a real-world series the short- and long-term results of segmentectomy and lobectomy for peripheral clinical stage IA non-small cell lung cancer. Methods Single center cohort study including a series of consecutive patients undergoing minimally invasive segmentectomy or lobectomy for peripheral (outer third of the lung) clinical stage IA non-small cell lung cancer (January2017-August 2022). Propensity score case matching analysis generated two matched groups of patients undergoing segmentectomy or lobectomy. Short term (morbidity and mortality) and long term (Overall and Event Free Survival) outcomes were compared between the two matched groups. Event free survival was calculated by including death resulting from any cause and any recurrence as events. Results Propensity score generated 118 pairs of patients undergoing minimally invasive segmentectomy or lobectomy. Median follow-up was 30 months (95%CL 4-64). Median postoperative length of stay was 4 days in both groups. 90-day mortality was similar (Segmentectomy 2.5% vs. Lobectomy 1.7%,p=1). 3 years overall survival (segmentectomy 87% (76-93) vs. lobectomy 81% (72-88),p=0.73) and event-free survival (segmentectomy 82% (72-90) vs. lobectomy 78% (68-84),p=0.52) didn’t differ between the groups. Locoregional recurrence rate (segmentectomy 4.2% (5/118) vs lobectomy 9.3% (11/118),p=0.19) was similar despite a lower nodal upstaging (segmentectomy 3.4%(4/118) vs. lobectomy 14%(17/118),p=0.005). The occurrence of compromised resection margins (pR1 or pR uncertain) was similar between the groups (segmentectomy 7.6% (9/118) vs. lobectomy 9.3% (11/118),p=0.81) Conclusions This observational series confirms the non-inferiority of segmentectomy compared to lobectomy in treating peripherally located stageIA non-small cell lung cancer.