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Eur J Cardiothorac Surg 2005;27:675-679
© 2005 Elsevier Science NL

A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients

Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK

Received 1 September 2004; received in revised form 30 December 2004; accepted 3 January 2005.

^* Corresponding author. Tel.: +44 116 256 3959; fax: +44 116 236 7768. (E-mail: david.waller{at}uhl-tr.nhs.uk).

Objective: Sublobar resections may offer a method of increasing resection rates in patients with lung cancer and poor lung function, but are thought to increase recurrence and therefore compromise survival for stage I non-small cell lung cancer (NSCLC). To test this hypothesis we have compared the long-term outcome from lobectomy and anatomical segmentectomy in high-risk cases as defined by predicted postoperative FEV₁ (ppoFEV₁) less than 40%. Methods: Over a 7-year period 55 patients (27% of all resections for stage I NSCLC) with ppoFEV₁<40% underwent resection of stage I NSCLC. The 17 patients who underwent anatomical segmentectomy were individually matched to 17 patients operated by lobectomy on the bases of gender, age, use of VATS, tumour location and respiratory function. We compared their perioperative course, tumour recurrence and survival. Results: There were no significant differences in hospital mortality (one case in each group), complications or hospital stay. Overall 5-year survival was 69%. There were no differences in recurrence rates (18% in both groups) or survival (64% after lobectomy and 70% after segmentectomy). There was preservation of pulmonary function after segmentectomy (median gain of 12%) compared to lobectomy (median loss of 12%) (P=0.02). Conclusions: Anatomical segmentectomy allowed for surgical resection in patients with stage I NSCLC and impaired respiratory reserve without compromising oncological results but with preservation in respiratory function.

Key Words: Lung resection • Outcomes • Thoracic surgery

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