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Three-Dimensional Guided Cone-Shaped Segmentectomy Versus Lobectomy for Small-sized Non-Small Cell Lung Cancer in the Middle Third of the Lung Field

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Segmentectomy has been recommended for peripheral small-sized non-small cell lung cancer (NSCLC). This study aimed to evaluate whether three dimensionally (3D) guided cone-shaped segmentectomy can achieve long-term outcomes comparable with lobectomy for small-sized NSCLC in the middle third of the lung parenchyma.

Methods

This study retrospectively screened patients with small NSCLC (≤2 cm) who underwent segmentectomy or lobectomy between January 2012 and June 2019. Tumor location was determined by 3D multiplanar reconstruction. The cone-shaped segmentectomy was performed with the guidance of 3D computed tomographic bronchography and angiography. The log-rank test, Cox hazard proportional regression, and propensity score-matching analyses were adopted for prognostic evaluation.

Results

After screening, 278 patients with segmentectomy and 174 subjects undergoing lobectomy were selected. All the patients had R0 resection, and no 30- or 90-day mortality was observed. The median follow-up time was 47.3 months. The 5-year overall survival (OS) was 99.6 %, and the disease-free survival (DFS) was 97.5 % for the patients undergoing segmentectomy. After propensity score-matching, the patients with segmentectomy (n = 112) had an OS (P = 0.530) and a DFS (P = 0.390) similar to those of the patients who underwent lobectomy (n = 112). The multivariable Cox regression analysis indicated no significant survival differences between segmentectomy and lobectomy [DFS: hazard ratio, 0.56 (95 % confidence interval (CI) 0.16–1.97, P = 0.369); OS: HR, 0.35 (95 % CI 0.06–2.06, P = 0.245)] after adjustment for other factors. Further analysis showed that segmentectomy achieved comparable OS (P = 0.540) and DFS (P = 0.930) for NSCLC in the middle-third and peripheral lung parenchyma (n = 454).

Conclusions

For selected NSCLCs size 2 cm or smaller in the middle third of the lung field, 3D-guided cone-shaped segmentectomy was able to achieve long-term outcomes comparable with lobectomy.

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Acknowledgement

The authors thank all the study participants, research staff, and students who participated in this study. The study was supported by the National Natural Science Foundation of China (82203296 & 81972175) and the Key Project of Jiangsu Commission of Health (ZD2022055).

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Author notes

  1. Zhihua Li and Wenzheng Xu have contributed equally to this article.

Authors and Affiliations

  1. Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

    Zhihua Li MD, Wenzheng Xu MD, Jun Wang MD, Quan Zhu MD, Weibing Wu MD & Liang Chen MD

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  1. Zhihua Li MD
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  2. Wenzheng Xu MD
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  3. Jun Wang MD
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  4. Quan Zhu MD
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Correspondence to Weibing Wu MD or Liang Chen MD.

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Supplementary file1 (DOCX 461 kb)

Right S2b+S3a combined subsegmentectomy by video-assisted thoracoscopic surgery (VATS). (MP4 121971 kb)

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Li, Z., Xu, W., Wang, J. et al. Three-Dimensional Guided Cone-Shaped Segmentectomy Versus Lobectomy for Small-sized Non-Small Cell Lung Cancer in the Middle Third of the Lung Field. Ann Surg Oncol 30, 6684–6692 (2023). https://doi.org/10.1245/s10434-023-13772-1

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  • DOI: https://doi.org/10.1245/s10434-023-13772-1

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