• Norifumi Tsubokawa, Takahiro Mimae, Akira Saeki, Yoshihiro Miyata, Chiaki Kanno, Yujin Kudo, Takuya Nagashima, Hiroyuki Ito, Norihiko Ikeda, and Morihito Okada.
• Department of Surgical Oncology, Hiroshima University, Horoshima, Japan.
• J. Thorac. Cardiovasc. Surg. 2024 Jul 3.

ObjectivesTo determine the feasibility of segmentectomy in patients with central, whole tumor size ≤2 cm and radiologically solid-dominant cN0 non-small cell lung cancer (NSCLC).MethodsWe retrospectively reviewed 1240 patients who underwent lobectomy or segmentectomy for small and radiologically solid-dominant cN0 NSCLC between January 2010 and December 2022. The inclusion criteria encompassed centrally located tumors, defined as tumors located in the inner two-thirds of the pulmonary parenchyma. Propensity score matching was applied to balance the baseline characteristics in the 2 study groups.ResultsAmong the 299 eligible patients, no significant differences in recurrence-free survival (RFS) and overall survival (OS) were observed between the segmentectomy (n = 121) and lobectomy (n = 178) groups (P = .794 and .577, respectively). After propensity score matching, no significant differences in hilar and mediastinal lymph node upstaging were found among the 93 matched patients (P = 1.00), and locoregional recurrence was comparable in the segmentectomy (n = 4) and lobectomy (n = 4) groups. RFS and OS did not differ significantly between the 2 groups (P = .700 and .870, respectively). Propensity score-adjusted multivariable Cox analysis for RFS and OS indicated that segmentectomy was not an independent prognostic factor (RFS: hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.43-1.85; P = .755; OS: HR, 1.09; 95% CI, 0.38-3.14; P = .860).ConclusionsSegmentectomy may be a viable treatment option, with local control and prognosis comparable to that of lobectomy in appropriately selected patients with central, small (≤2 cm), and radiologically solid-dominant NSCLC.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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