Outcome of segmentectomy vs. lobectomy in patients with cT1a -b N0 lung cancer and postoperative N1 upstaging

PURPOSE: Segmentectomy is offered in selected patients with clinical T1a-b N0 M0 lung cancer. In case of positive N1 lymph node at fresh frozen section, conversion to lobectomy is recommended. Indication for redo surgery and completion lobectomy in case of positive N1 lymph node at final pathology is highly debated. We aim to compare the outcome between segmentectomy and lobectomy in patients with cT1a-b N0 M0 lung cancer with postoperative N1-upstaging. METHODS: We retrospectively reviewed all patients with pT1a-b N1cM0 lung cancer who underwent surgical resection with lymph node dissection between January 2013 and January 2024 at our institution. We included patients with tumor size ≤ 2 cm and postoperative N1-upstaging. Disease-free (DFS) and overall (OS) survivals were calculated from the date of surgery until recurrence or death and were compared between the groups. RESULTS: Twenty-five patients with cT1a-b N0 M0 lung cancer and postoperative N1-upstaging were identified. Median age was 64 years (42-81). Sixteen (64%) patients underwent lobectomy There was no significant difference in tumor size (median: 1,1, IQR[Formula: see text]1,1-1,8[Formula: see text] vs. 1,5, IQR[Formula: see text]1,4 - 1,8[Formula: see text], p = 0.186) and FEV1% (median: 76, IQR[Formula: see text]74- 92[Formula: see text] vs. 75, IQR[Formula: see text]69- 87[Formula: see text], p = 0.656) between segmentectomy and lobectomy groups. Number of lymph nodes removed was significantly lower in the segmentectomy group (median: 10, IQR[Formula: see text]4- 26[Formula: see text] vs. 23, IQR[Formula: see text]14- 32[Formula: see text] p = 0.035). Median follow-up was 53, IQR[Formula: see text]41- 63[Formula: see text] months. There was no difference in 5-year DFS (72.9%vs 70.5%, p = 0.502) and OS (85,7%vs. 85,6%, p = 0.233) between the groups. CONCLUSION: In patients who underwent segmentectomy or lobectomy for cT1a-b N0 M0 lung cancer and postoperative N1-upstaging, no difference in survivals was seen in our cohort.