Oncological and Surgical Outcomes of Left Trisegmentectomy or Lingulectomy Versus Upper Lobectomy for Early-Stage Non-Small Cell Lung Cancer: A Multicentre Study

Objectives: Left upper lobe and right upper and middle lobes have a similar anatomical structure; therefore, multi-segmentectomy (S), as upper trisegmentectomy and lingulectomy, should guarantee the same oncological radicality as left upper lobectomy (LUL). The aim of the study was to compare the oncological and surgical outcomes of left upper S (trisegmentectomy or lingulectomy) and LUL for early-stage (cT1-T2bN0M0) non-small cell lung cancer (NSCLC). Methods: Clinical data of patients who underwent S or LUL, without any previous neoadjuvant treatment, from June 2016 to March 2024 at 9 high-volume centres, were retrospectively reviewed. To reduce any selection bias, a 1:1 propensity score matching (PSM) was performed. Results: After PSM, 105 patients, with comparable clinical-pathological characteristics, were included in each group. A significant difference between LUL and S was recorded in terms of postoperative complications (P=.014), mainly air-leak (P=.055), without differences in hospitalization (P=.333). The median follow-up (FUP) time was 23 months (interquartile range [IQR]: 13-42). The 5-year overall survival (OS) and disease-free survival (DFS) were 95% vs 80% (P=.072) and 97%vs 83%(P=.090) for LUL and S, respectively. When analysing only cases with tumour-to-margin distance of <1 cm, the 5-year OS and DFS were LUL: 98% vs S: 64%(P=.049) and LUL: 96% vs S: 87%(P=.056), respectively. If the distance was>1 cm, the 5-year OS (P=.193) and DFS (P=.351) were comparable in both groups, as for tumour-diameter > 2 cm (5-year OS (P=.429) and DFS (P=.602)). In the S cohort, no difference was found between lingulectomy and trisegmentectomy in terms of 5-year OS (P=.240) and DFS (P=.304). At multivariable analysis, positive spread-through air spaces (STAS) was the only significant predictor for DFS in S group (P=.027). Conclusions: Oncological outcomes of left upper trisegmentectomy or lingulectomy for early-stage NSCLC are comparable with those of LUL, if the tumour is located more than 1 cm from the surgical margin. Positive STAS is the only predictor for shorter DFS in S group.