Propensity matching analysis of left upper tri-segmentectomy versus lobectomy for stage I non-small cell lung cancer.

Abstract

Background: The equivalence between left upper lobectomy (LUL) and left upper tri-segmentectomy (LUTS) for stage I left upper non-small cell lung cancer (NSCLC) remains unclear. This study compares the perioperative and oncological outcomes of LUL and LUTS in this patient population.

Methods: This study included patients who underwent LUL or LUTS at West China Hospital of Sichuan University and Sichuan ShangJin Hospital between August 2018 and November 2023. Patients with tumors located at least 2 cm from the lingular segment were included. Propensity score matching (PSM) addressed baseline imbalances between groups. Perioperative outcomes, overall survival (OS), recurrence-free survival (RFS), lung cancer-specific survival (LCSS), and subgroup analyses were assessed.

Results: A total of 1019 patients were included (LUL: 524; LUTS: 495) with a median follow-up of 4.8 years (IQR: 2.5-8.1). Compared to LUL, LUTS was associated with significantly shorter operative times (103 vs. 120 min, p = 0.001), reduced postoperative drainage volume at 3 days (335 vs. 485 ml, p = 0.001) and total (360 vs. 530 ml, p = 0.001), lower conversion to thoracotomy rates (1.0% vs. 3.4%, p = 0.009), and fewer postoperative complications (9.9% vs. 14.9%, p = 0.016). No significant differences were observed in 5-year OS (86.7% vs. 85.4%, HR: 0.96; 95% CI: 0.66-1.39; p = 0.821), 5-year RFS (78.4% vs. 75.3%, HR: 0.85; 95% CI: 0.63-1.13; p = 0.258), or 5-year LCSS (90.2% vs. 91.3%, HR: 0.99; 95% CI: 0.62-1.57; p = 0.956) between the two groups.

Conclusion: For stage I left upper NSCLC, LUTS, while preserving adequate surgical margins, achieves superior perioperative and comparable oncological outcomes to LUL.