Loco-regional recurrence after segmentectomy for peripheral and radiologically solid-dominant tumors

OBJECTIVES Segmentectomy is a standard treatment for small-sized, peripherally located, and radiologically solid-dominant non-small cell lung cancer. However, its effectiveness in loco-regional control compared with lobectomy for such tumors remains undetermined. METHODS We evaluated the clinicopathological findings, recurrence patterns, and prognosis of patients with radiologically determined ≤2-cm sized, solid-dominant, and peripheral non-small cell lung cancer without lymph node involvement clinically. These patients underwent complete resections via segmentectomy (n = 332) or lobectomy (n = 609) between 2010–2020. Median follow-up duration for anonymized patients was 48.8 months. RESULTS Among the 941 patients, loco-regional recurrence occurred in seven (2%) patients following segmentectomy and in 30 (5%) following lobectomy (P = 0.037). Surgical stump recurrences occurred in three (1%) patients in a segmentectomy group and in five (0.8%) patients in a lobectomy group. Among patients with pure solid tumors, no significant difference in loco-regional recurrence was noted between the segmentectomy (seven patients, 4%) and lobectomy (27 patients, 7%) groups (P = 0.11). Surgical stump recurrence occurred in three (1.5%) patients following segmentectomy and in three (0.7%) patients following lobectomy. Fine–Gray proportional hazard regression analysis with adjusted variables, including age, sex, Brinkman index, solid tumour size, presence of ground glass opacity, and SUVmax, revealed that the surgical procedure was not a risk factor for loco-regional recurrence. CONCLUSIONS Regardless of tumour malignant grade, segmentectomy provides comparable local control with lobectomy for selected small-sized peripheral non-small cell lung cancer.