Comparative Assessment of Individualized Segmentectomy Versus Standard Lobectomy in Patients With Early-Stage Non-Small Cell Lung Cancer.

[AIM] The optimal surgical strategy for clinical stage IA non-small cell lung cancer (NSCLC) remains under active investigation. This study aimed to compare the perioperative outcomes, functional preservation, and short-term oncologic results between individualized segmentectomy and standard lobectomy.

[METHODS] This retrospective cohort study included 205 patients with histologically confirmed clinical stage IA (T1a-cN0M0) NSCLC who underwent surgery at Changzhou Cancer Hospital between January 2017 and June 2023. According to the type of surgical procedure, patients were classified into the individualized segmentectomy group or the standard lobectomy group. Perioperative variables, postoperative complications (graded by Clavien-Dindo classification), pulmonary function recovery (forced expiratory volume in one second (FEV1), diffusing capacity of the lung for carbon monoxide (DLCO)), pain scores (visual analog scale (VAS)), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30)), and 2-year recurrence rates were analyzed between these two groups.

[RESULTS] A total of 205 NSCLC patients were analyzed in this study (segmentectomy: n = 101; lobectomy: n = 104). Compared with the lobectomy group, the segmentectomy group showed significantly reduced intraoperative blood loss, lower drainage volume, earlier chest tube removal, and a shorter length of hospital stay (p < 0.05). Compared with the lobectomy group, the segmentectomy group had significantly lower early postoperative pain scores and significantly higher quality of life scores (p < 0.05). Pulmonary function was better preserved in the segmentectomy group at both 1 and 3 months postoperatively (p < 0.05). However, no significant difference was observed in the 2-year tumor recurrence rate between the two study groups (p > 0.05).

[CONCLUSIONS] Individualized segmentectomy offers perioperative and functional advantages over standard lobectomy in patients with early-stage NSCLC, without compromising short-term oncologic safety. These findings support its application as a lung parenchyma-sparing surgical option in appropriately selected patients.