Overall 5-year survival rate and disease-free survival after segmentectomy versus lobectomy in patients with non-small cell lung cancer

Objectives: Anatomical lobectomy has always been the standard operative treatment of early-stage non-small cell lung cancer. However, there have been emerging evidences suggesting that a subanatomical resection, such as segmentectomy, may yield the same treatment results, even in patients with higher-stage non-small cell lung cancer. This study aimed to compare overall 5-year survival rate and disease-free survival between lobectomy and segmentectomy in patients with non-small cell lung cancer. Methods: The retrospective study included 380 patients who underwent surgery for non-small cell lung cancer at Ramathibodi Hospital between 1st January 2016 and 31st December 2020. Of 380 patients, 307 patients underwent lobectomy, while the other 73 patients underwent segmentectomy. Operative, admission, and follow-up data were collected from electronic medical records. Missing data were collected by telephone calls to patients or their relatives in deceased cases. Overall and disease-free survival were analyzed. Results: Median overall 5-year survival time after lobectomy and segmentectomy seemed to be different but not statistically significant (18.5 months versus 5.8 months, p = 0.127). Median disease-free survival time after lobectomy and segmentectomy was also similar (8.6 months versus 4.5 months, p = 0.511). Two deaths occurred during perioperative period, one from lobectomy group due to acute massive pulmonary embolism (0.3%) and the other from segmentectomy group due to acute exacerbation of chronic obstructive pulmonary disease with respiratory failure (1.4%). Conclusion: Lobectomy and segmentectomy result in similar overall 5-year survival rate and disease-free survival between these two comparison groups. Therefore, segmentectomy may be a potential alternative for operative treatment of non-small cell lung cancer. However, a larger and randomized-controlled trial may be needed to further validate these results.