The importance of lobectomy versus segmentectomy in stage I NSCLC

Lung cancer remains the leading cause of death among oncological patients worldwide. Surgical resection offers the optimal prognosis for patients with early-stage non-small cell lung cancer (NSCLC). Lobectomy with lymph node dissection is traditionally the gold standard in resectable NCSLC. The continuous aging of the population results in a larger number of patients with NSCLC who are older and more fragile. On the other side, medical technology contributes in early detection of small lung tumors. Under the light of these new data, many scientists question the role of lobectomy, in favor of sublobar resection, as anatomical segmentectomy, for parenchyma preservation. Recent randomised controled trials examined the non-inferiority of segmentectomy compared to lobectomy for Stage I NSCLC. We had the opportunity to analyze the data of 40 patients with Stage I NSCLC who were operated at the <<Attikon>> University Hospital. Thirteen patients underwent anatomical segmentectomy and 27 lobectomy. The 5-year overall survival reached 84% after segmentectomy and 74% after lobectomy. However, the risk of local relapse was 2.3 times higher for segmentectomy compared to lobectomy. In conclusion, segmentectomy gains ground under circumstances and lobectomy remains the gold standard in stage I NSCLC.