Real-world outcomes of lobectomy, segmentectomy and wedge resection for the treatment of stage c-IA lung carcinoma
Authors: Thomas Pascal Alexandre , Seguin-Givelet Agathe , Pages Pierre-Benoît , Alifano Marco , Brouchet Laurent , Falcoz Pierre-Emmanuel , Baste Jean-Marc , Glorion Matthieu , Belaroussi Yaniss , Filaire Marc , Heyndrickx Maxime , Loundou Anderson , Fourdrain Alex , Dahan Marcel , Boyer Laurent ,   EPITHOR working group, Seguin-Givelet Agate , Fallouh Ahed , de Lambert Albéric , Vlas Ana Claudia , Claret Antoine , Defontaine Antoine , Legras Antoine , Minniti Antonio , Pforr Arnaud , Moret Aurelien , Aubert Axel , Orsini Bastien , Delepine Benoît , Lahon Benoît , De Latour Bertrand Richard , Berbescu Bogdan , Pektova-Marteau Boriana , Cosma Catalin , Perrotin Cedric , Berton Christophe , Jayle Christophe , Klein Christophe , Lancelin Christophe , Angelescu Dan , Kaczmarek David , Sage Edouard , Martinod Emmanuel , Brechet Eric , De La Roche Eric , Mensier Eric , de Dominicis Florence , Mazeres Florence , Charot Florent , Le Pimpec-Barthes Francoise , Singier Gaetan , Cardot Gilles , Grosdidier Gilles , Boddaert Guillaume , Bouabdallah Ilies , Jougon Jacques , Assouad Jalal , Levi Jean François , Baste Jean Marc , Maury Jean Michel , Arigon Jean Philippe , Choplain Jean-Noel , Avaro Jean-Philippe , Berthet Jean-Philippe , Le Rochais Jean-Philippe , Bellier Jocelyn , Riviere Joel , Pfeuty Karel , Solovei Laurence , Brouchet Laurent , Benhamed Lotfi , Mazzoni Lucia , Eraldi Luciano , Gust Lucile , Grigoroiu Madalina , Dabboussi Maher , Filaire Marc , Alifano Marco , Durand Marion , Coblence Mathieu , Peret Matthieu , Tabutin Mayeul , Alauzen Michel , Ammi Myriam , Santelmo Nicola , Venissac Nicolas , Alsit Nidal , Mercier Olaf , Aze Olivier , Hagry Olivier , Pagès Olivier , Tiffet Olivier , Thomas Pascal , Bagan Patrick , Boitet Philippe , Dalous Philippe , Kleinmann Philippe , Lacoste Philippe , Rinieri Philippe , Mordant Pierre , Tesson Pierre , Pages Pierre-Benoît , Falcoz Pierre-Emmanuel , Bonnet Pierre-Mathieu , Brichon Pierre-Yves , Taam Salam Abou , Franco Sebastien , Guinard Sophie , Jaillard-Thery Sophie , Renaud Stéphane , Anne Valentine , Blin Vincent , Casanova Vincent , De Kerangal Xavier 
Published: June 2024

Abstract

OBJECTIVES
To determine safety and survival outcomes associated with lobectomy, segmentectomy and wedge resection for early-stage lung cancer by quiring the French population-based registry EPIdemiology in THORacic surgery (EPITHOR).

METHODS
Retrospective analysis of 19 452 patients with stage c IA lung carcinoma who underwent lobectomy, segmentectomy or wedge resection between 2016 and 2022 with curative-intent. Main outcome measures were 90-day mortality and 5-year overall survival estimates. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patient, tumour and practice environment factors.

RESULTS
The treatment distribution was 72.2% for lobectomy, 21.5% for segmentectomy and 6.3% for wedge. Unadjusted 90-day mortality rates were 1.6%, 1.2% and 1.1%, respectively (P = 0.10). Unadjusted 5-year overall survival estimates were 80%, 78% and 70%, with significant inter-group survival curves differences (P &lt; 0.0001). Multivariable proportional hazards regression showed that wedge was associated with worse overall survival [adjusted hazard ratio (AHR), 1.23 (95% confidence interval 1.03–1.47); P = 0.021] compared with lobectomy, while no significant difference was disclosed when comparing segmentectomy to lobectomy (1.08 [0.97–1.20]; P = 0.162). The three-way propensity score analyses confirmed similar 90-day mortality rate for wedge resection and segmentectomy compared with lobectomy (hazard ratio: 0.43; 95% confidence interval 0.16–1.11; P = 0.081 and 0.99; 0.48–2.10; P = 0.998, respectively), but poorer overall survival (1.45; 1.13–1.86; P = 0.003 and 1.31; 1–1.71; P = 0.048, respectively).

CONCLUSIONS
Wedge resection was associated with comparable 90-day mortality but lower overall survival when compared to lobectomy. Overall, all types of sublobar resections may not offer equivalent oncologic effectiveness in real-world settings.