Lobectomy Is Not Associated With Improved Survival as Compared to Segmentectomy in Early-Stage Lung Cancer Patients With Visceral Pleural Invasion

Gregory L Whitehorn; Hamza Rshaidat; Isheeta Madeka; Jonathan Martin; Shale J Mack; Luke Meredith; Sneha Alaparthi; Tyler R Grenda; Nathaniel R Evans 3rd; Olugbenga T Okusanya

doi:10.1016/j.cllc.2024.11.007

Lobectomy Is Not Associated With Improved Survival as Compared to Segmentectomy in Early-Stage Lung Cancer Patients With Visceral Pleural Invasion

Clin Lung Cancer. 2024 Nov 18:S1525-7304(24)00253-5. doi: 10.1016/j.cllc.2024.11.007. Online ahead of print.

Affiliations

¹ Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
² Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
³ Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: Olugbenga.Okusanya@jefferson.edu.

PMID: 39672786
DOI: 10.1016/j.cllc.2024.11.007

Abstract

Objective: The purpose of this study is to utilize a representative national sample to compare survival outcomes of patients with visceral pleural invasion (VPI) who underwent either a lobectomy or a segmentectomy.

Methods: National Cancer Database from 2010 to 2019 was utilized. Patients with tumor size ≤ 2 cm, with VPI, non-small cell lung cancer (NSCLC), with a known vital status were included in the study. A propensity match analysis was performed to compare VPI patients undergoing either lobectomy or segmentectomy.

Results: Of the 66,181 patients who met the inclusion criteria, 6,575 (9.9%) had VPI. In postmatch analysis, there was no significant difference in 5-year survival in patients whose cancer had VPI and underwent either lobectomy or segmentectomy (76 [77.1%] vs. 71 [65.7%]; P = .23). Patients who underwent lobectomy and had VPI had poorer 5-year survival compared to patients who underwent a lobectomy and did not have VPI (1,154 [73.7%] vs. 1,240 [78.5%]; P < .001). There was no difference in 5-year survival between patients who underwent a segmentectomy and had VPI and patients who underwent a segmentectomy and did not have VPI (71 [65.7%] vs. 79 [71.0%]; P = .36).

Conclusion: A lobectomy was not associated with improved survival as compared to patients who underwent a segmentectomy in patients with early-stage NSCLC with VPI. VPI remains a poor prognostic factor for survival regardless of the procedure performed. This data would indicate that the presence of VPI should not be a determining factor in the anatomic lung resection selected in patients with small, early-stage NSCLC.

Keywords: Lobectomy; Lung Cancer; Pleural Invasion; Segmentectomy; Survival.