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Segmentectomy or Lobectomy in T1N0M0 Non-Small Cell Lung Carcinomas: The Prognostic Role of Histology and Vascular Invasion
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DOI：10.1007/s13304-026-02628-4.png)
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Abstract
En 中文
Introduction Lobectomy is the standard surgical approach for early-stage non-small cell lung cancer (NSCLC), while segmentectomy has gained increasing attention as a parenchyma-sparing alternative. Recent randomized prospective trials have demonstrated comparable survival outcomes between the two procedures in patients with peripherally located, node-negative NSCLC <= 2 cm. This study aimed to compare survival outcomes between segmentectomy and lobectomy in patients with T1N0 NSCLC. Methods We conducted a retrospective, multicenter study using data from six thoracic surgery clinics across T & uuml;rkiye. Initially, 317 patients who underwent segmentectomy and 252 who underwent lobectomy were identified. After 1:1 propensity score matching with a 20% tolerance for demographic differences, 223 patients from each group were included. The groups were compared in terms of clinical, pathological, and survival characteristics. Results After matching, baseline characteristics were well-balanced. The segmentectomy group had a significantly higher rate of VATS procedures and adenocarcinoma histology (both p < 0.001). In contrast, the lobectomy group had larger tumors and higher rates of pleural, perineural, lymphatic, and vascular invasion, as well as STAS (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.02 respectively). Segmentectomy was associated with a shorter hospital stay and fewer pulmonary complications (p < 0.001 and p = 0.002, respectively). Although median survival was longer in the segmentectomy group, the difference was not statistically significant (p = 0.062). Non-adenocarcinoma histology and vascular invasion were identified as independent predictors of poor prognosis (p < 0.001 and p = 0.017, respectively). Conclusions Segmentectomy offers comparable survival to lobectomy in T1N0 NSCLC while providing perioperative advantages. Histological subtype and vascular invasion remain important prognostic factors, necessitating close monitoring in high-risk patients.
Keywords:
Early stage non-small cell lung cancer
Sublobar resection
Segmentectomy
Lobectomy
Vascular invasion
Histology
Prognostic factor
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