WCLC 2025 - Posters & ePosters-P1.07.02 Septum-Guided Segmentectomy vs Lobectomy for Deeply Located cT1abN0M0 Non-Small Cell Lung Cancer

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This retrospective cohort study from Shanghai Chest Hospital evaluated septum-guided segmentectomy versus lobectomy for deeply located (inner two-thirds, tumor centrality ratio ≥0.67) clinical T1abN0M0 non-small cell lung cancer (NSCLC) in 407 patients between 2019–2024, with propensity score matching yielding 98 patients per group.<br /><br />Traditionally, lobectomy is recommended for such central tumors to ensure adequate margins. However, this study innovatively utilized intersegmental septa as reliable anatomical barriers to guide segmentectomy, eliminating the need for fixed margin distances. The surgical approach was uniportal VATS with a 3-cm incision, dissecting the intersegmental venous sheath to perform en bloc resection of tumor-bearing segments.<br /><br />Results showed that segmentectomy achieved oncologic outcomes equivalent to lobectomy. With a median follow-up of 25 months, there were zero recurrences or deaths in the segmentectomy group compared to six events in the lobectomy group pre-matching. After matching, overall survival and recurrence-free survival were statistically comparable (p=1.0). Both groups had 100% R0 resection rates. Segmentectomy had a longer operative time (approximately 129 vs. 92 minutes; p<0.001) but no significant difference in complication rates, prolonged air leaks, or hospital stays.<br /><br />The study challenges current NCCN guidelines mandating lobectomy for central tumors by demonstrating lung function-preserving segmentectomy can be oncologically safe for inner two-thirds tumors. It expands the role of sublobar resections without compromising survival, highlighting the septum-guided technique’s anatomical rationale.<br /><br />Future research directions emphasize prospective, multicenter trials with larger populations and longer follow-up to validate these findings and refine patient selection criteria. This could fundamentally alter surgical management of deep NSCLC by favoring lung-preserving segmentectomies over lobectomies where appropriate.

Asset Subtitle

Qing Wang

Meta Tag

Speaker Qing Wang

Topic Early-Stage Non-small Cell Lung Cancer

Keywords

septum-guided segmentectomy

lobectomy

deeply located NSCLC

clinical T1abN0M0

propensity score matching

uniportal VATS

intersegmental septa

oncologic outcomes

lung function preservation

surgical management of NSCLC