Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer

Background. Segmentectomy for early-stage non-small cell lung cancer (NSCLC) remains controversial and has been previously associated with high local recurrence rates. We compared the outcomes of anatomic segmentectomy with lobectomy for stage I NSCLC and investigated the impact of surgical resection margins on recurrence. Methods. From 2002 to 2006, 182 anatomic segmentectomies ( 114 open, 68 video-assisted thoracic surgery [ VATS]), were performed for stage 1A (n = 109) or IB ( n = 73) NSCLC. These were compared with 246 lobectomies ( 1A, 114; 1B, 132). Variables analyzed included hospital course, mortality, and patterns of recurrence and survival. Results. All segmentectomy surgical margins were free of tumor ( average margin, 18.2 mm). Operative time ( 147 versus 216 minutes; p < 0.0001) and estimated blood loss ( 185 versus 291 mL; p = 0.0003) were significantly reduced after segmentectomy compared with lobectomy. Thirty-day mortality (1.1% versus 3.3%), total complications, disease-free recurrence, and survival were similar between segmentectomy and lobectomy at a mean follow-up of 18.1 and 28.5 months, respectively. There were 32 recurrences after segmentectomy (17.6%) at a mean of 14.3 months ( 14 locoregional [7.7%], 18 distant [9.9%]), and 89% of recurrences were seen when tumor margins were 2 cm or less. Margin/tumor diameter ratios exceeding 1 were associated with a significant reduction in recurrence rates compared with ratios of less than 1 (25.0% versus 6.2%; p = 0.0014). Conclusions. Anatomic segmentectomy can be performed safely by an open or VATS approach. Segmentectomy outcomes compare favorably with standard lobectomy for stage I NSCLC. Margin/tumor ratios of less than 1 are associated with a higher rate of recurrence. Lobectomy should be considered as primary therapy when such margins are not obtainable with segmentectomy in the good-risk patient.