Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis

Eur J Cardiothorac Surg. 2020 Jun 1;57(6):1051-1060. doi: 10.1093/ejcts/ezz339.

Abstract

Objectives: The role of segmentectomy in early-stage non-small-cell lung cancer (NSCLC) remains a matter of debate. We performed a meta-analysis to evaluate the oncological outcomes following segmentectomy versus lobectomy for stage I, stage IA only and stage IA <2 cm only.

Methods: We systematically searched the literature for articles reporting on overall survival (OS), cancer-specific survival (CSS) or recurrence-free survival (RFS). The hazard ratios (HRs) were retrieved and pooled using an inverse variance-weighted approach.

Results: Twenty-eight studies were included in the analysis. In stage I, segmentectomy was found to be inferior to lobectomy for all 3 outcomes with HR: 1.25 (P = 0.01) for OS, 1.59 (P = 0.02) for CSS and 1.40 (P < 0.001) for RFS. In stage IA, the differences were significant for OS and CSS, though not for RFS with HR: 1.31 (P = 0.04), 1.56 (P = 0.02) and 1.22 (P = 0.11), respectively. In stage IA <2 cm, no significant differences were found between segmentectomy and lobectomy with HR: 1.13 (P = 0.37) for OS, 1.02 (P = 0.95) for CSS and 1.24 (P = 0.11) for RFS.

Conclusions: For stages I and IA, lobectomy showed superior results whereas for tumours <2 cm, our study did not find significant differences in oncological outcomes between both groups. These results suggest that segmentectomy might be a valuable alternative to lobectomy for NSCLC in tumours <2 cm.

Keywords: Limited resection; Lobectomy; Non-small-cell lung cancer; Segmentectomy.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Carcinoma, Non-Small-Cell Lung* / pathology
  • Carcinoma, Non-Small-Cell Lung* / surgery
  • Humans
  • Lung Neoplasms* / pathology
  • Lung Neoplasms* / surgery
  • Neoplasm Staging
  • Pneumonectomy
  • Survival Rate