475P - 5-year overall survival and disease free survival outcome between lobectomy and segmentectomy for early stage lung cancer in a mixed Asian population

Background

Lobectomy had long been the established gold standard curative surgery for early stage lung cancer. With emerging evidence on the non-inferior outcome of segmentectomy, we had been performing segmentectomy on selected stage 1 lung cancer patients in our institution since 2012. It is timely for us to review our experience with segmentectomy in this group of patients.

Methods

We reviewed all the patients in our institution who underwent curative lung resection in a mixed Asian population over a 12-year period between 2006 and 2017. Staging was based on AJCC TNM 6^th edition for patients before 2010 and 7^th edition for patients after 2010. Only patients with stage 1 lung cancer were included in our study.

Results

269 patients were included in our study. 39 patients (14.5%) underwent segmentectomy, 225 patients (83.6%) underwent lobectomy and 5 patients (1.9%) underwent pneumonectomy. None of the segmentectomy cases had any visceral pleura or lymph node involvement reported on final histology. There was no significant difference in the mean duration of follow up between patients who had segmentectomy (5.37 +/- 2.94 years) and those who had lobectomy and above (6.41 +/- 3.43 years) (p = 0.083). Segmentectomy was associated with a significantly lower recurrence rate (OR 0.19, 95% CI 0.05-0.75) and a 5-year disease free survival of 96.6% compared to 73.1% in lobectomy patients (p = 0.002). The time to recurrence was also longer in segmentectomy patients (mean 4.25 +/- 3.53 years vs 2.78 +/- 2.23 years) but this was not statistically significant (p = 0.371). There was no significance difference in the short term 30-day survival between patients who underwent segmentectomy and lobectomy and above. There was also no significant difference in survival at 1, 3 and 5 years between the 2 groups of patients.

Conclusions

Our study demonstrated good disease-free survival in patients who underwent segmentectomy with no significant differences in overall survival. It is likely that careful selection of patients will produce equally good outcome in segmentectomy patients and this can give us renewed confidence in moving forward with lung preservation surgery for patients with early stage lung cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.