Comparing Operative Approaches in the Management of NSCLC

By: Joshua D. Madera, MD
Posted: Thursday, February 13, 2025

For patients with stage I non–small cell lung cancer (NSCLC), operative management with a left-upper trisegmentectomy may be a more favorable treatment strategy than a left-upper lobectomy, according to a study published in the World Journal of Surgical Oncology. Using the trisegmentectomy approach, patients had improved perioperative and similar oncologic outcomes as compared with the lobectomy approach while achieving good surgical margins, explained Qiang Pu, MD, of West China Hospital, Sichuan University, Chengdu, and colleagues.

“Left-upper lobectomy has been the standard treatment for tumors located in the left-upper lobe, even when the tumor is confined to the trisegment and spares the lingular segment,” noted the study authors. “Future research should investigate the long-term impact of left-upper trisegmentectomy on survival, recurrence, and quality of life, particularly in diverse patient populations, including those of varying age groups and with comorbidities.”

From 2018 to 2023, a total of 1,019 patients with NSCLC were recruited for the study. All patients had tumors that were located at least 2 cm from the lingula. Patients were stratified based on the surgical approach used to manage their tumors—left-upper lobectomy (n = 524) or left-upper trisegmentectomy (n = 495)—and their clinical outcomes were monitored.

The study authors reported that patients treated with trisegmentectomy had significantly reduced operative times (103 minutes) compared with patients treated with lobectomy (120 minutes). Similarly, trisegmentectomy led to significantly decreased total postoperative drainage volume (360 mL), a reduced number of postoperative complications (9.9%), and a lower rate of conversion to a thoracotomy (1.0%) compared with lobectomy. However, when the investigators assessed clinical outcomes at the 5-year postoperative interval, no significant differences were observed for the rates of overall survival (86.7% for trisegmentectomy and 85.4% for lobectomy), lung cancer–specific survival (90.2% and 91.3%, respectively), and recurrence-free survival (78.4% and 75.3%, respectively) between patients treated with trisegmentectomy and lobectomy.

Disclosure: The study authors reported no conflicts of interest.

World Journal of Surgical Oncology

---