Oncologic outcomes of segmentectomy in c-stage I non-small cell lung cancer with visceral pleural invasion: A multicenter retrospective study.

OBJECTIVES: Given the increased recurrence risk associated with visceral pleural invasion (VPI) and its unique subpleural lymphatic pathways, this study aimed to compare survival and recurrence patterns between segmentectomy and lobectomy in patients with small-sized (≤3 cm), radiologically solid-dominant clinical stage I non-small cell lung cancer (NSCLC) with pathologic VPI. METHODS: We retrospectively reviewed the data of 2247 patients who underwent segmentectomy or lobectomy for small-sized (≤3 cm), radiologically solid-dominant clinical stage I NSCLC across multiple institutions between 2010 and 2022. Baseline characteristics were balanced using propensity score matching. RESULTS: Overall, 418 patients had pathologic VPI. Among them, 81 (19%) patients underwent segmentectomy, and 337 (81%) underwent lobectomy. Pathologic lymph node metastasis occurred in 99 (23%) patients, with no significant difference between the 2 groups (P = .135). After propensity score matching (n = 79 each), overall survival and recurrence-free survival did not significantly differ between the 2 groups (P = .645 and P = .629, respectively). In the propensity score-matched cohort, multivariable Cox analysis showed that segmentectomy was not an independent prognostic factor for overall survival (hazard ratio, 0.63; 95% CI, 0.26-1.48; P = .287) and recurrence-free survival (hazard ratio, 0.85; 95% CI, 0.45-1.56; P = .594). The locoregional recurrence rates were similar between the segmentectomy and lobectomy groups (10% vs 9%, respectively). CONCLUSIONS: Segmentectomy was not associated with worse survival or local recurrence compared with lobectomy in this selected multicenter retrospective cohort of patients with small-sized, radiologically solid-dominant clinical stage I NSCLC with pathologic VPI.