Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer

Abstract Background The oncologic efficacy of segmentectomy is controversial. We compared long- term survival in clinical stage IA (T1N0) patients undergoing lobectomy and segmentectomy in Medicare patients in the STS database. Methods The Society of Thoracic Surgeons General Thoracic Surgery Database (STS- GTSD) was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n=1654) or lobectomy (n=12,632) for clinical stage IA disease from 2002-15. Cox regression was used to create a long-term survival model. Patients were then propensity matched on demographic and clinical variables to derive matched pairs. Results In Cox modeling, segmentectomy is associated with survival similar to lobectomy in the entire cohort [HR 1.04, 95%CI (0.89,1.20), P=0.64] and in the matched subcohort. A subanalysis restricted to the 2009-15 population (n=11,811), when T1a tumors were specified and PET scan results and mediastinal staging procedures were accurately recorded in the database, also showed that segmentectomy and lobectomy continue to have similar survival [HR 1.00, 95% CI (0.87,1.16)]. Subanalysis of the pathologic N0 patients demonstrated the same results. Conclusions Lobectomy and segmentectomy for early stage lung cancer are equally effective treatments with similar survival. STS surgeons appear to be selecting patients appropriately for sublobar procedures.