Lobectomy versus segmentectomy in patients with T1N2 non-small cell lung cancer: An analysis of the National Cancer Database

Objective: To assess survival outcomes for patients with stage IIIA (T1N2M0) non- small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). Methods: Patients with T1N2M0 NSCLC undergoing lobectomy or segmentectomy were identified in the NCDB from 2004 to 2019. Patient characteristics were compared using X (2) and Fisher exact tests. Overall survival was evaluated using the Kaplan-Meier method and the Cox proportional hazard analysis adjusting for type of resection, age, sex, and margin positivity, Charlson comorbidity index, number of lymph nodes examined, number of positive lymph nodes, and tumor size. Results: In total, 2883 patients with T1N2 NSCLC undergoing segmentectomy or lobectomy were identified. The majority (96.5%) of patients received lobectomy and 100 (3.5%) patients received segmentectomy. Patients undergoing segmentectomy were older (P = .001) and had tumors in the lower lobe of the lung (P = .001) versus patients undergoing lobectomy. Fewer patients who received segmentectomy underwent radiation (P = .015) and neoadjuvant chemotherapy (P = .041). Fewer patients undergoing segmentectomy had>10 lymph nodes examined and > 5 positive nodes compared with patients receiving lobectomy (both P < .001). Although 30-day readmission rates were similar (P = .27), 30-day mortality was lower in the segmentectomy cohort (P = .047). There was a significantly lower risk of death among patients undergoing lobectomy versus segmentectomy (hazard ratio, 0.96; 95% confidence interval, 0.94-0.98; P = .001). Conclusions: In this NCDB analysis, lobectomy was more commonly performed for T1N2 NSCLC compared with segmentectomy. Lobectomy offered a significant survival advantage over segmentectomy, even when adjusting for risk factors. Thus, these fi ndings suggest that lobectomy may be a superior resection of choice for patients with T1N2 disease. (JTCVS Open 2024;21:304-12)