Anatomical split-lobe resections versus lobectomy for left upper lobe NSCLC ≤3 cm: A propensity score–matched analysis

Background The optimal extent of resection for left upper lobe nonsmall cell lung cancer (NSCLC) ≤ 3 cm remains controversial. Because the upper division and lingula represent two distinct bronchovascular units, anatomical split-lobe resection may provide an oncologically sound parenchyma-sparing alternative to left upper lobectomy (LUL). This study compared perioperative and long-term oncological outcomes between these procedures. Methods This single-center retrospective study included patients who underwent anatomical resection for pathological stage 0–II left upper lobe NSCLC ≤3 cm between 2010 and 2025. Among 199 eligible patients (145 LUL, 54 segmentectomy), 1:1 propensity score matching yielded 54 matched pairs. Perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) were analyzed. Results After matching, baseline characteristics were well balanced. Perioperative outcomes, including postoperative complications, prolonged air leak, length of hospital stay, and 30-day mortality, were comparable between groups. R0 resection was achieved in all patients. Five-year OS (67.1% vs. 63.4%, p = .585) and RFS (69.1% vs. 65.7%, p = .920) were similar between anatomical split-lobe resection and LUL. In multivariable analysis, increasing age and male sex were independently associated with worse OS, whereas resection type was not. Conclusions Anatomical split-lobe resection (upper division segmentectomy or lingulectomy) provides perioperative and long-term oncological outcomes comparable to LUL in carefully selected patients with left upper lobe NSCLC measuring ≤3 cm.