WCLC 2025 - Posters & ePosters-P1.07.28 Segmentectomy vs Lobectomy for Clinical Stage IA1-2 NSCLC and Upstaging Due to Pathologic Visceral Pleura Infiltration

P1.07.28 Segmentectomy vs Lobectomy for Clinical Stage IA1-2 NSCLC and Upstaging Due to Pathologic Visceral Pleura Infiltration

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This retrospective study from the Lung Clinic at Hospital Cologne-Merheim analyzed outcomes of lobectomy versus segmentectomy in 46 patients with clinical stage IA1-2 non-small cell lung cancer (NSCLC) who were postoperatively upstaged to stage IB due to pathologic visceral pleura invasion. The cohort included 18 patients undergoing lobectomy and 28 undergoing segmentectomy, with comparable demographic and clinical profiles. Most surgeries (89%) were performed via VATS. Segmentectomy cases involved fewer lymph nodes removed (median 15.5 vs. 22.5, p=0.031) and smaller resection margins (median 2.15 cm vs. 3.4 cm, p=0.028) than lobectomy, though no completion lobectomies followed segmentectomy. <br /><br />Five-year disease-free survival (DFS) was 62% for segmentectomy and 83% for lobectomy (p=0.393), while overall survival (OS) was 49% and 63%, respectively (p=0.213), showing no statistically significant differences between surgical approaches. A margin-to-tumor ratio of at least 1 correlated with improved DFS (87% vs. 39%, p=0.019). In patients with a Charlson-Deyo comorbidity score ≥5, lobectomy demonstrated better survival (100% vs. 44%, p=0.031). <br /><br />The findings suggest that despite upstaging from IA1-2 to IB due to visceral pleura infiltration, segmentectomy provides survival outcomes comparable to lobectomy, indicating that completion lobectomy may not be necessary in these cases. The study supports segmentectomy as an acceptable surgical option in this context but highlights the need for further research to confirm these preliminary results. This evidence could impact surgical decision-making, potentially sparing select patients from more extensive resections when visceral pleura invasion is discovered postoperatively.

Asset Subtitle

Hafsa Kaman

Meta Tag

Speaker Hafsa Kaman

Topic Early-Stage Non-small Cell Lung Cancer

Keywords

lobectomy

segmentectomy

non-small cell lung cancer

clinical stage IA1-2

pathologic visceral pleura invasion

disease-free survival

overall survival

video-assisted thoracoscopic surgery (VATS)

margin-to-tumor ratio

Charlson-Deyo comorbidity score