To compare left-upper, right and left inferior split-lobe procedures with the same lobectomies for surgical treatment of peripheral non-small cell lung cancer of stage IA-IB, originating from the large pulmonary lobes.
We analyzed the results of the treatment of 116 patients, who underwent surgical procedures for clinical stage IA-IB non-small cell lung cancer. Patients were divided into two groups, based on the type of procedure performed. Lobectomies were performed in 78 (67,2%) patients, split-lobe resections of the large pulmonary lobes in 38 (32,8%): upper left trisegmentectomy (S1,2,3) in 14 patients, resection of the lingula (S4,5) in 7, anatomical segmentectomy S6 in 15, resection of basal segments in 2 patients. Radical mediastinal lymph node dissection was performed in all cases. The primary end-points of the analysis were relapse-free survival (RFS), overall survival (OS) and rate of recurrence (RR).
There were no significant differences in morbidity between lobectomy and split-lobe resection groups (7,7% vs. 5,3%; p=NS). RR was registered in 9 patients in the lobectomy group vs 7 patients from split-lobe group (11,5% vs. 18,4%; p=NS). Regional recurrence in hilar lymph nodes was confirmed only in one patient from split-lobe group 28 months after right anatomical segmentectomy S6. Survival analysis did not show significant differences between lobectomy and split-lobe groups. Overall 5-year survival was 82,0% (95% confidence interval, 70,3-93,7%) in lobectomy group versus 74,8% (95% confidence interval, 57,5-97,1%) in split-lobe group (p = 0,369). Relapse-free 5-year survival was 85,2% (95% confidence interval, 76,8-94,6%) in lobectomy group versus 76,2% (95% confidence interval, 59,6-92,8%) in split-lobe group (p = 0,353). Cox regression analysis with multiple factors demonstrated statistical significance for overall (p = 0,03) and relapse-free (p = 0,025) survival only for pT1-T2 tumour descriptors.
Split-lobe procedures and lobectomy have equivalent in-hospital morbidity and long-term results for patients with clinical stage IA-IB peripheral non-small cell LC. In the future split-lobe resection can be recommended as a standard procedure for early stage peripheral non-small cell LC.
Clinical trial identification
Legal entity responsible for the study
City Clinical Hospital no. 40.
Has not received any funding.
All authors have declared no conflicts of interest.