PURPOSE: There is increasing enthusiasm with the use of anatomic segmentectomy as definitive surgical management for pathologic stage I NSCLC. Many reports focusing on the role of sublobar resection for stage I lung cancer have focused on pathologic stage, which may bias the perceived oncologic value of sublobar resection for clinical stage I disease. As surgical decision-making is based upon clinical stage, we compared the outcomes of patients undergoing wedge resection (n=130), anatomic segmentectomy (n=235), or lobectomy (n=728) for clinical stage I NSCLC.
METHODS: All patients (n=1093) undergoing resection for clinical stage I NSCLC from 2002-2009 were included. Primary outcome variables included recurrence patterns and survival. Statistical analysis included the t-test and Fisher’ s exact test. The probability of recurrence-free and overall survival was estimated with the Kaplan-Meier method, with significance being estimated by the log rank test.
RESULTS: Mean age (67.9, range: 22-99), gender, histology were similar between groups. Average tumor size was 2.9 cm (range: 0.1-23). Final pathology demonstrated upstaging in 244 (22.3%) patients. Mean follow-up was 30.5 months. Wedge resection was associated with increased locoregional recurrence compared with segmentectomy (14.6% vs. 8.9%,p=0.006). Anatomic segmentectomy was associated with reduced mortality (0.4% vs. 1.8%,p=0.12), as well as equivalent locoregional recurrence (p=0.50) and recurrence-free survival (p=0.36) compared to lobectomy. There was no difference in overall survival between the three resection groups. Among pathologically up-staged patients, survival was not impacted by the extent of surgical resection utilized.
CONCLUSION: Anatomic segmentectomy is associated with reduced peri-operative mortality and similar recurrence and survival patterns compared to lobectomy in the management of clinical stage I NSCLC. Both anatomic segmentectomy and lobectomy achieve superior locoregional control compared to non-anatomic wedge resection for clinical stage I disease.
CLINICAL IMPLICATIONS: The decision to choose anatomic segmentectomy vs. lobectomy appears to achieve equivalent oncologic success in the management of clinical stage I NSCLC. Wedge resection, however, remains a “compromised” procedure reserved for the physiologically-impaired patient unable to undergo anatomic resection.
DISCLOSURE: Matthew Schuchert, No Financial Disclosure Information; No Product/Research Disclosure Information