European multicentre study evaluating the prognosis of peripheral early-stage lung adenocarcinoma patients operated on by segmentectomy or lobectomy

Objectives: To analyse impact of segmentectomy on oncological outcomes of different peripheral early-stage lung adenocarcinoma patterns. Methods: Retrospective multicentre study including patients who underwent either lobectomy or segmentectomy in 6 European centres from 2015 to 2021, for ≤2 cm pathological peripheral lung adenocarcinoma. Overall and disease-free survivals were assessed by cox-regression and lung cancer-specific survival by competing regression analyses to adjust for patient- and tumour-related factors both in the entire dataset and the in aggressive adenocarcinoma patterns dataset. Results: Lobectomy and segmentectomy were performed in 481 (71%) and 193 (29%) patients, respectively. Propensity score matching was performed (n = 191). One hundred and 8 patients had a least an aggressive pattern. Five-year disease-free, overall and lung cancer-specific survivals were similar between patients who underwent lobectomy or segmentectomy in both entire and aggressive pattern datasets. In patients with aggressive pattern, 5-year disease-free (lobectomy 87.3%; segmentectomy 86.6%, P = 0.62), overall (lobectomy 86.4%; segmentectomy 95.6%, P = 0.61) and lung cancer-specific (lobectomy 100%; segmentectomy 95.6%, P = 0.13) survivals did not differ. Segmentectomy was not an independent risk factor for disease-free survival, neither for overall survival nor for lung cancer-specific survival in any of the 2 datasets. In patients with aggressive pattern, loco-regional recurrence (linearized risks: lobectomy 8.21; segmentectomy 11.3) was higher in patients who underwent segmentectomy. Conclusions: Resection should not be extended (to lobectomy) on patients who underwent segmentectomy for pathologically proven early-stage adenocarcinoma with aggressive patterns.