Anatomical Segmentectomy versus Lobectomy for cT1N0M0 NSCLC Upstaged to pT2aN0M0 by Occult Visceral Pleural Invasion: a multicenter cohort study

Abstract Objectives Occult visceral pleural invasion (VPI) may upstage cT1N0M0 non-small cell lung cancer (NSCLC) to pT2aN0M0. We compared perioperative and oncological outcomes after segmentectomy and lobectomy in this setting. Methods This multicenter retrospective study included cT1N0M0 NSCLC patients treated with minimally invasive segmentectomy or lobectomy who were subsequently upstaged to pT2aN0M0 because of VPI. Propensity score matching (PSM) (1:1) was performed. Perioperative and oncological outcomes were compared. Exploratory and sensitivity analyses evaluated tumors ≤20 mm and patients who did not receive adjuvant therapy. Results Among 448 patients, 104 underwent segmentectomy and 344 lobectomy. After PSM, 87 matched pairs were analyzed. Segmentectomy was associated with shorter operative time, lower postoperative morbidity, and shorter hospital stay. No significant differences were observed in DFS (p = 0.387), OS (p = 0.075), or CSS (p = 0.388). Multivariable analysis identified adjuvant therapy and age as independent predictors of DFS and OS, respectively, whereas the extent of resection was not independently associated with survival. In patients with a preoperative CT total tumor diameter ≤20 mm, segmentectomy was associated with a higher rate of local recurrence (13.8vs2.0%, p = 0.037) and worse adjusted DFS and OS, despite no significant differences in Kaplan–Meier survival. Conclusions In patients with cT1N0M0 NSCLC upstaged to pT2aN0M0 because of occult VPI, segmentectomy was associated with lower postoperative morbidity, with no significant differences in oncological outcomes in the overall matched cohort. Exploratory findings in patients with a preoperative CT total tumor diameter ≤20 mm suggest a higher risk of local recurrence and worse adjusted DFS and OS after segmentectomy, warranting further validation.

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Journal
European Journal of Cardio-Thoracic Surgery
Published
2026-10-09
DOI
https://doi.org/10.1093/ejcts/ezag241
Primary Topic
Lung Cancer Diagnosis and Treatment
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article
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article

Anatomical Segmentectomy versus Lobectomy for cT1N0M0 NSCLC Upstaged to pT2aN0M0 by Occult Visceral Pleural Invasion: a multicenter cohort study

Beatrice Leonardi, Corrado Pedrazzani, Andrea Billè, Francesco Londero et al.
European Journal of Cardio-Thoracic Surgery
Lung Cancer Diagnosis and Treatment
article

Anatomical Segmentectomy versus Lobectomy for cT1N0M0 NSCLC Upstaged to pT2aN0M0 by Occult Visceral Pleural Invasion: a multicenter cohort study

Beatrice Leonardi, Corrado Pedrazzani, Andrea Billè, Francesco Londero, Tommaso Valigi, Luca Luzzi, Luca Voltolini, Riccardo Giovannetti, Chiara Catelli, Alessio Campisi, Andrea Zuin, Nicola Tamburini, Alessandro Bonis, Giovanni Mugnaini, Stefano Bongiolatti, Andrea Dell’Amore, Dania Nachira, Alessandro Rebusso, Nicola Sarnicola, Francesco Dolcetti, Hauke Winter, Alfonso Fiorelli, Micayla Pather, Giampiero Dolci, Stefano Margaritora, Wentao Fang, Yang Chen, Rebecca Weedle, Martin Eichhorn, Filippo Lococo, Tiziano Conti
article en

Abstract

Abstract Objectives Occult visceral pleural invasion (VPI) may upstage cT1N0M0 non-small cell lung cancer (NSCLC) to pT2aN0M0. We compared perioperative and oncological outcomes after segmentectomy and lobectomy in this setting. Methods This multicenter retrospective study included cT1N0M0 NSCLC patients treated with minimally invasive segmentectomy or lobectomy who were subsequently upstaged to pT2aN0M0 because of VPI. Propensity score matching (PSM) (1:1) was performed. Perioperative and oncological outcomes were compared. Exploratory and sensitivity analyses evaluated tumors ≤20 mm and patients who did not receive adjuvant therapy. Results Among 448 patients, 104 underwent segmentectomy and 344 lobectomy. After PSM, 87 matched pairs were analyzed. Segmentectomy was associated with shorter operative time, lower postoperative morbidity, and shorter hospital stay. No significant differences were observed in DFS (p = 0.387), OS (p = 0.075), or CSS (p = 0.388). Multivariable analysis identified adjuvant therapy and age as independent predictors of DFS and OS, respectively, whereas the extent of resection was not independently associated with survival. In patients with a preoperative CT total tumor diameter ≤20 mm, segmentectomy was associated with a higher rate of local recurrence (13.8vs2.0%, p = 0.037) and worse adjusted DFS and OS, despite no significant differences in Kaplan–Meier survival. Conclusions In patients with cT1N0M0 NSCLC upstaged to pT2aN0M0 because of occult VPI, segmentectomy was associated with lower postoperative morbidity, with no significant differences in oncological outcomes in the overall matched cohort. Exploratory findings in patients with a preoperative CT total tumor diameter ≤20 mm suggest a higher risk of local recurrence and worse adjusted DFS and OS after segmentectomy, warranting further validation.

European Journal of Cardio-Thoracic Surgery
Università Cattolica del Sacro Cuore (IT), Guy's Hospital (GB), University of Padua (IT), Guy's and St Thomas' NHS Foundation Trust (GB), Heidelberg University (DE), University Hospital Heidelberg (DE), Agostino Gemelli University Polyclinic (IT), Ospedale Santa Chiara (IT), Azienda Unità Sanitaria Locale di Ferrara (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Arcispedale Sant'Anna (IT), University of Campania "Luigi Vanvitelli" (IT), Shanghai East Hospital (CN), German Center for Lung Research (DE), Azienda Ospedaliera Universitaria Senese (IT), University of Florence (IT), Misericordia University (US)
Openalex Percentile: Top 12%
Lung Cancer Diagnosis and Treatment
DOISourceOpenAlex
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