Oncological feasibility of segmentectomy for inner-located lung cancer.

OBJECTIVE: Oncological feasibility of segmentectomy for internal non-small cell lung cancer (NSCLC) has not been assessed adequately. We assessed the oncological feasibility of segmentectomy for inner-located NSCLC by investigating surgical margins and patient prognosis after undergoing the procedure.

METHODS: Of the 3555 patients who underwent resection for lung cancer between 2013 and 2019 at our institution, 659 patients who underwent segmentectomy for clinical stage 0 to stage1A NSCLC were included in this study. Patients were separated into 2 groups according to whether the tumor was in the inner or outer third of the lung area. Clinical characteristics and prognoses were retrospectively compared between the groups.

RESULTS: Of the included 659 cases, 183 (27.8%) were inner-located, and 476 (72.2%) had outer-located NSCLC. The surgical margin was significantly shorter in the inner-located group than in the outer group (median, 16 vs 25 mm; P  < .001). The 5-year recurrence-free survival and overall survival probabilities were 91.1%/91.8% ( P  = .530) and 94.1%/95.6% ( P  = .345) for inner/outer-located groups, respectively. Multivariate analysis showed that clinical stage IA2 or 3 ( P  = .043), lymphovascular invasion ( P  < .001), and surgical margins <20 mm ( P  = .017) were independent prognostic factors for recurrence-free survival. The location of the inner or outer tumors was not related to the prognosis.

CONCLUSIONS: For clinical stage 0 to stage1A NSCLC, tumor location in the inner two-thirds of the lung was not associated with prognosis after segmentectomy. Because one of the independent prognostic factors is margin distance, segmentectomy for inner-located NSCLC would be oncologically acceptable when an adequate surgical margin is secured.