Dye Localization Extended Segmentectomy vs. Lobectomy for Deep Intersegmental Early-Stage Lung Cancer

<b>Background:</b> Computed tomography-guided dye localization facilitates extended segmentectomy with reliable oncologic margins for deep intersegmental early-stage lung cancer. This study evaluated perioperative and long-term outcomes in comparison with those of lobectomy. <b>Methods:</b> We retrospectively reviewed patients with early-stage lung adenocarcinoma ≤ 2 cm who underwent computed tomography-guided dye localization extended segmentectomy between 2013 and 2019 and compared them with those who underwent lobectomy between 2011 and 2016. After 1:1 propensity score matching based on demographic and clinical variables, 30 matched pairs were included in the analysis. <b>Results:</b> Compared with lobectomy, extended segmentectomy with computed tomography-guided dye localization was associated with shorter operative time (102 ± 34 vs. 181 ± 42 min, <i>p</i> < 0.001), less blood loss (0 [0-0] vs. 0 [0-62.5] mL, <i>p</i> < 0.001), shorter chest tube duration (1 [1-2] vs. 2 [2-3] d, <i>p</i> = 0.002), reduced hospital stay (3 [3-4] vs. 5 [4-6] d, <i>p</i> < 0.001), and smaller ipsilateral (10.4 [1.9-15.7] vs. 20.0 [10.0-26.2] %, <i>p</i> = 0.004) and total (1.3 [-3.5-6.4] vs. 6.5 [1.4-12.9] %, <i>p</i> = 0.022) lung volume reductions at 6 months. All patients achieved negative resection margins. Lymph node yield was lower in the segmentectomy group (<i>p</i> < 0.001); however, the 5-year overall and disease-free survival rates were comparable. <b>Conclusions:</b> Computed tomography-guided dye localization extended segmentectomy provides favorable perioperative and functional outcomes and achieves comparable oncologic control in selected patients with deep intersegmental early-stage lung adenocarcinoma, representing a potential alternative to lobectomy.