Long-Term Results of Segmentectomy vs. Lobectomy for c-Stage IA Lung Cancer: A Real-Life Study with a Propensity Score Analysis Based on a National Cohort

<b>Background/Objectives</b>: The objective was to compare the results of segmentectomy and lobectomy in the treatment of c-stage IA lung cancer in terms of tumor recurrence and 5-year survival. <b>Methods:</b> An observational study was performed using 3533 patients included in the registry of the Spanish VATS Group (GEVATS) of the Spanish Society of Thoracic Surgery (SECT) between 2016 and 2018. A total of 1004 lobectomies and 83 segmentectomies in c-stage IA were selected. Two comparable groups were selected through 2:1 propensity score matching with patient-, tumor- and surgery-related variables, leaving 166 lobectomies and 83 segmentectomies. Tumor recurrence was analyzed by Fisher's test and overall, cancer-specific, recurrence-free and disease-free survival by Kaplan-Meier and Log-rank tests. <b>Results:</b> Overall recurrence was 23.7% in both groups, with a predominance of locoregional recurrence in segmentectomy (16.2% vs. 11.2%) and distant recurrence in lobectomy (12.5% vs. 7.5%). There was no difference between the two groups in any of the survival types. Overall survival at 5 years was 73.5% (95% CI: 65.5-82.4%) in the lobectomy group vs. 73.1% (95% CI: 60.1-88.9%) in the segmentectomy group. <b>Conclusions:</b> Anatomic segmentectomy may be a valid option in the treatment of c-stage IA lung cancer since the recurrence and long-term survival outcomes compared to lobectomy are equivalent.