Outcomes of sublobar resection vs lobectomy for invasive clinical stage T1N0 non‐small‐cell lung cancer: A propensity‐match analysis

BACKGROUND: The role of sub lobar resection (SLR; either segmentectomy or wedge resection) vs lobectomy (LBCT) for invasive clinical stage T1N0 non‐small‐cell‐lung‐cancer (NSCLC) has not been fully established yet. AIM: We aimed to characterize the preoperative parameters leading to selecting SLR and compare the overall survival (OS) and disease‐free survival (DFS) of these two surgical approaches. METHODS: Clinical data on 162 patients (LBCT‐107; SLR‐55) were prospectively entered in our departmental database. Preoperative parameters associated with the performance of SLR were identified using univariate and multivariate cox regression analysis. The Kaplan‐Meier method was used to compute OS and DFS. Comparison between LBCT and SLR groups and 32 propensity‐matched groups was performed using Log‐rank test. RESULTS: Median follow‐up time for the LBCT and SLR groups was 4.76 (Inter‐quartile range [IQR] 2.96 to 8.23) and 3.38 (IQR 2.9 to 6.19) years respectively. OS and DFS rates were similar between the two groups in the entire cohort (OS‐LBCT vs SLR P = .853, DSF‐LBCT vs SLR P = .653) and after propensity matching (OS‐LBCT vs SLR P = .563 DSF‐LBCT vs SLR P = .632). Specifically, Two‐ and five‐year OS rates for LBCT and SLR were 90.6.% vs 92.7%, 71.8% vs 75.9% respectively. Independent predictors of selecting for SLR included older age (P < .001), reduced FEV1% (P = .026), smaller tumor size (P = .025), smaller invasive component (P = .021) and higher American Society of Anesthesiology scores (P = .014). CONCLUSIONS: In 162 consecutive and 32 matched cases, SLR and lobar resection had similar overall and disease‐free survival rates. SLR may be considered as a reasonable oncological procedure in carefully selected T1N0 NSCLC patients that present with multiple comorbidities and relatively small tumors.