Is Lobectomy Associated With Improved Outcomes Compared to Segmentectomy in Small Cell Lung Cancer Discovered at the Time of Resection?

[BACKGROUND] Small cell lung cancer (SCLC) represents approximately 10%-15% of all lung cancer cases in the United States. The extent of surgery for early-stage SCLC remains controversial,with the treatment standard being chemotherapy or chemoradiotherapy. We aim to evaluate outcomes among the patients who underwent a lobectomy or segmentectomy in SCLC diagnosed on the day of resection.

[METHODS] This retrospective cohort study utilized the NCDB. We examined patients >18 who underwent a lobectomy or segmentectomy between 2010 and 2019 who had clinically node negative SCLC diagnosed at the time of resection. Outcome variables include 5- year, 30-day, 90-day mortality and readmission rates. Propensity score matching was utilized to compare outcomes between groups.

[RESULTS] 564 patients were examined, with a mean age of 68. Males comprised of 42.9% of the cohort. 65 (12%) patients underwent segmentectomy and 499 (88%) patients underwent lobectomy. There were no differences in nodal upstaging (P = .31) and T stage upstaging (P = .37) between the 2 cohorts. 90.2% of the population was clinical stage I (P = .003). There were no significant differences in 5- year, 30-day, 90-day mortality (P = .22, P = .40, P = .77), and readmission (P = .57) in this cohort. After PSM (n = 118) there continued to be no significant difference in all outcomes between cohorts.

[CONCLUSIONS] In this study, we found that rates of T and N upstaging, 5-year mortality, and short-term outcomes did not differ amongst cohorts, showing that patients who undergo segmentectomy may not benefit from undergoing a more extensive resection.