Minimally Invasive Anatomical Segmentectomy versus Lobectomy in Stage IA Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis †

SIMPLE SUMMARY: The detection rate of small peripheral lung nodules has risen dramatically due to the advances in lung cancer screening programs. Approximately 10% of these nodules are malignant non-small cell lung cancer (NSCLC). While current EVIDENCE suggests that lobectomy and segmentectomy have comparable outcomes for patients with stage IA NSCLC, certain studies have suggested that segmentectomy has a worse prognosis than lobectomy. Furthermore, the superiority of segmentectomy in retaining pulmonary function remains debatable. The Japanese randomized control trial JCOG0802/WJOG4607L was the first phase 3 trial to demonstrate the superiority of segmentectomy over lobectomy in terms of overall patient survival, indicating that segmentectomy should become the standard surgical treatment for early-stage patients. Our study aimed to conduct a systematic review and meta-analysis to establish whether minimally invasive anatomical segmentectomy and lobectomy had comparable perioperative and survival outcomes in early-stage NSCLC patients. ABSTRACT: Objective. A systematic review and meta-analysis was performed to assess potential differences in perioperative outcomes and disease-free survival (DFS) and overall survival (OS) of patients with pathological stage IA non-small cell lung cancer (NSCLC) who underwent minimally invasive anatomical segmentectomy or lobectomy. Methods. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of EMBASE (through Ovid), MEDLINE (via PubMed), and Cochrane CENTRAL was conducted. Two researchers independently reviewed each eligible study that included patients with stage IA NSCLC who underwent minimally invasive anatomical segmentectomy and lobectomy and compared perioperative and/or survival outcomes of patients. Results. A total of 887 publications were identified. Of these, 10 articles met our eligibility criteria. A significantly higher number of lymph nodes were harvested in lobectomies. The two groups did not significantly differ in postoperative complication rates, DFS, and OS. Patients who underwent segmentectomy had shorter postoperative hospital stays. Conclusions. Minimally invasive lobectomy and segmentectomy showed comparable short-term and long-term outcomes in stage IA NSCLC patients. Postoperative complication rates were similar. Minimally invasive lobectomies are associated with a higher number of harvested lymph nodes, although this did not affect the final staging or the survival outcomes.