Left Upper Lobectomy vs Trisegmentectomy for Lung Cancer: A Propensity Score–Matched Comparison

The left upper division (segments I-III) and the lingula (segments IV and V) are analogous to the right upper and middle lobes, respectively. Whereas bilobectomy for right upper lobe tumors is rare, left upper division tumors are often resected by left upper lobectomy (LUL) rather than by left upper trisegmentectomy (LU3S). To assess safety and oncologic efficacy of LUL vs LU3S, we compared short- and long-term outcomes after both procedures. Patients undergoing LUL or LU3S for clinical stage IA-IIA non-small cell lung cancer in the left upper division from January 2006 to December 2020 were identified from an institutional database. Propensity score matching was used to control for clinical differences. We identified 229 cases meeting inclusion criteria: 131 (57.2%) LUL, 98 LU3S. After matching, 83 cases were included in each group. Median clinical tumor size was similar for LUL vs LU3S (2.2 cm [interquartile range, 1.6-3.0 cm] vs 2.1 cm [interquartile range, 1.7-2.9 cm]; P = .80). Total lymph nodes sampled did not differ between LUL and LU3S (median, 7 vs 6; P = .36), nor did patterns of N2 sampling (P = .11). Odds of postoperative complications did not differ after LUL vs LU3S (odds ratio, 0.75; 95% CI, 0.39-1.46). No 30-day death was observed. Median follow-up was 72 months. There was no statistically significant difference in 5-year overall survival (75.9% vs 82.1%; P = .28) or locoregional recurrence-free survival (73.7% vs 80.0%; P = .23) after LUL vs LU3S. Our findings suggest that LU3S and LUL have equivalent short- and long-term outcomes in patients with clinical stage IA-IIA non-small cell lung cancer in the left upper division.