Lobectomy vs. sublobectomy for stage I non-small-cell lung cancer: a meta-analysis

Background: Although lobectomy is widely regarded as the treatment of choice for early-stage non-small-cell lung cancer (NSCLC), sublobectomy (segmentectomy and wedge resection) has emerged as an alternative modality over the years. Only a handful of studies has compared the treatment effects of these two surgical interventions. This study aimed to analyze the treatment effects between lobectomy and sublobectomy on the survival outcomes of patients with stage I NSCLC systematically. Methods: PubMed, Embase, and the Cochrane Library were systematically searched from their inception up to February 2019 for studies that compared the survival outcomes of lobectomy and sublobectomy. Studies that reported the diagnosis of stage I NSCLC by imaging or pathophysiology, lobectomy as intervention, sublobectomy as control, and overall survival (OS) and disease-free survival (DFS) as outcomes were included. The mean OS and DFS rates were calculated using the fixed-effects model. Results: A total of 12 studies that included 4,373 patients with stage I NSCLC were included in the meta-analysis. The patients who underwent lobectomy showed a significant improvement in OS than those who underwent sublobectomy (P=0.025). These results differed when stratified by publication year (before 2010 and after 2010), study design (prospective and retrospective), country (Eastern and Western), control (segmentectomy and wedge), and study quality (high and low), but no significant differences were observed in DFS. These results were not altered in the sensitivity and subgroup analyses. Conclusions: Stage I NSCLC patients who undergo sublobectomy display poor OS, whereas the DFS is similar for both methods.