Subsegment-Based vs Segment-Based Anatomical Sublobar Resection for Lung Cancer: A Propensity Score-Matched Analysis.

Abstract

The study investigators speculated that, in comparison with the standard sublobar resection based on segment (SLR-Seg), sublobar resection based on smaller anatomic unit of subsegment (SLR-Subseg) could achieve comparable surgical margin status while preserving more pulmonary parenchyma. The study screened all patients undergoing SLR-Subseg or SLR-Seg for clinical T1 N0 M0 lung cancer from June 2014 to December 2020 at The First Affiliated Hospital with Nanjing Medical University (Nanjing, China). Propensity score matching was conducted at a 1:1 ratio with a caliper width of 0.1 SD of the logit propensity score. Of 1126 patients, 410 (36.4%) underwent SLR-Subseg and 716 (63.6%) underwent SLR-Seg. The rate of inadequate margins (<2 cm or the tumor size, whichever smaller) was 18.4% (56 of 305) in the SLR-Subseg group vs 19.2% (97 of 505) in the SLR-Seg group (P = .84). The median number of resected subsegments was 2 (interquartile range, 1-3) in the SLR-Subseg vs 3 (interquartile range, 2-4) in the SLR-Seg group (P < .001). With a median follow-up of 4.4 years, the 5-year relapse-free survival rates were equivalent between groups (99.0% vs 97.7%; P = .22). In the propensity score matching analysis (339 patients in each group), the rate of inadequate margin was 17.9% vs 16.5% (P = 0.77), and the median number of resected subsegments was 2 (interquartile range, 1-3) vs 3 (interquartile range, 2-4) (P < .001) in the SLR-Subseg vs SLR-Seg group. In comparison with SLR-Seg, SLR-Subseg was associated with a comparable rate of inadequate surgical margin and a lower number of resected subsegments in patients with early-stage lung cancer.