Anatomical Sublobar Resection for Multi-Intersegmental Pulmonary Nodules.

[BACKGROUND] Anatomical sublobar resection (ASR) is non-inferior to lobectomy for peripheral small-sized lung cancer. However, for nodules located in complex locations, ASR is usually challenging. This study aimed to compare the outcomes of ASR and lobectomy for multi-intersegmental pulmonary nodules.

[METHODS] Patients with pulmonary nodules (≤ 2 cm) who underwent ASR or lobectomy between 2012 and 2023 were retrospectively screened. The 3D multiplanar reconstruction software was used to determine the precise tumor localization. Demographic, radiomic, histopathologic, and perioperative characteristics between ASR and lobectomy were compared. The log rank test was adopted for prognostic evaluation. Propensity score-matching (PSM) analysis was conducted to yield matched patients.

[RESULTS] In total, 93 patients undergoing ASR and 118 subjects undergoing lobectomy were included. Patients with ASR were younger and had a smaller tumor size, fewer solid nodules, and more central nodules than those with lobectomy. ASR achieved a median surgical margin of 2.0 cm, removed fewer lymph nodes, and preserved seven more subsegments than lobectomy (5 vs. 12, p < 0.001), without increasing air leak or postoperative hospital stay. During a median follow-up of 32 months, four patients in the lobectomy group encountered tumor recurrence, whereas no recurrence occurred in the ASR group. The 5-year recurrence-free survival (RFS) after lobectomy and ASR was 95.4% and 100%, respectively. After PSM, 34 matched patients remained in each group, and the RFS was 100% in both groups.

[CONCLUSIONS] ASR is feasible for multi-intersegmental nodules and can preserve more pulmonary parenchyma with no compromise in perioperative and oncological outcomes compared to lobectomy.