All segments are created equal: locoregional recurrence and survival after single versus multi-segment resection in patients with clinical stage IA ≤ 2 cm non-small cell lung cancer.

Abstract

Objectives: Compare oncologic outcomes between single-segment and multi-segment resections in patients with clinical stage IA1 and IA2 non-small cell lung cancer.

Methods: A retrospective review (2011-2022) was conducted using a prospectively maintained database. Patients undergoing anatomical segmentectomy for clinical stage IA ≤ 2 cm non-small cell lung cancers were included. Patients were grouped into single-segment and multi-segment resections. Patients were excluded if they had neuroendocrine tumors, small cell lung cancer, underwent wedge resection, or lobectomy. The primary outcome was loco-regional recurrence. Secondary outcomes of disease-free survival, loco-regional recurrence-free survival, overall survival, pathologic upstaging, and perioperative complications were evaluated.

Results: 190 (63.8%) patients had single-segment resection and 108 (36.2%) had multi-segment resection. The single-segment resection group had smaller tumors (1.3 vs 1.45 cm, p = 0.02), but no significant difference in margin length (1.7 vs 2 cm, p = 0.15). Fewer lymph nodes were resected in single-segment resection (7 vs 10, p < 0.001), and a significantly lower rate of pathologic upstaging (4.2% vs 10.2%, p = 0.03) was observed compared with multi-segment resection. Nevertheless, loco-regional recurrence developed in 6.3% of patients after single-segment resection and 7.4% patients following multi-segment resection (p = 0.72). With a median follow-up duration of 40 months, five-year disease-free survival, loco-regional recurrence-free survival, and overall survival was 73%, 89%, and 87% following single-segment resection compared to 78%, 95%, and 84% after multi-segment resection.

Conclusions: For patients with clinical stage IA non-small cell lung cancers ≤2 cm, loco-regional recurrence and survival is not different based on whether patients receive a single-segment or multi-segment resection.