Extent of resection in surgically resected stage IV non-small cell lung cancer: Results from two tertiary referral centers.

Abstract

The benefits of pulmonary resection as local consolidative therapy for stage IV non-small cell lung cancer (NSCLC) have been clearly demonstrated in appropriate patients. For early-stage disease, debate continues regarding the role of anatomic versus parenchymal-sparing resection. We explored the impact of resection extent on outcomes for stage IV NSCLC. Patients were identified from 2 thoracic surgery departments. Included patients underwent pulmonary resection for stage IV NSCLC between 1996 and 2023. Resection extent was categorized as sublobar, lobar, or greater than lobar. The primary outcome was development of locoregional recurrence (adjacent to the surgical margin, ipsilateral hemithorax, or regional lymph nodes). A multivariable binomial logistic regression was performed for locoregional recurrence. Kaplan-Meier analyses evaluated survival outcomes. In total, 179 patients were included, with mean age of 58.8 years (interquartile range, 51.8-66.5 years). The mean number of metastases was 1.68 (interquartile range, 1.0-2.0). A total of 116 (64.8%) patients received neoadjuvant treatment, with 22 (12.3%) achieving complete response, and 31 (17.3%) patients underwent sublobar resection, 130 (72.6%) lobectomy, and 18 (10.1%) more extensive resections. Locoregional recurrence occurred in 24 (13.4%) patients, including 2 (6.4%) in the sublobar group, 20 (15.4%) lobectomy group, and 2 (11.1%) greater-than-lobectomy group. Extent of resection did not independently predict locoregional recurrence (sublobar resection odds ratio, 0.44, P = .30; greater than lobar odds ratio, 0.48, P = .51). Overall (P = .14) and progression-free survival (P = .35) were similar between groups. Resection extent in stage IV NSCLC does not impact subsequent locoregional recurrence, highlighting the importance of identifying relevant guidelines for optimal oncologic outcomes in patients undergoing surgery for metastatic disease.