Real-world outcomes of lobectomy, segmentectomy and wedge resection for the treatment of stage c-IA lung carcinoma
P. Thomas, Agathe Seguin‐Givelet, P Pagès, Marco Alifano, L. Brouchet, Pierre‐Emmanuel Falcoz, Jean‐Marc Baste, Matthieu Glorion, Yaniss Belaroussi, Marc Filaire, Maxime Heyndrickx, Anderson Loundou, Alex Fourdrain, M. Dahan, Laurent Boyer, EPITHOR working group, Agate Seguin-Givelet, Ahed Fallouh, Albéric de Lambert, Ana Claudia Vlas, Antoine Claret, Antoine Defontaine, Antoine Legras, A Minniti, Arnaud Pforr, Aurelien Moret, Axel Aubert, Bastien Orsini, Benoît Delepine, Benoît Lahon, Bertrand Richard De Latour, Bogdan Berbescu, Boriana Pektova-Marteau, Cătălin Cosma, C. Perrotin, C. Berton, Christophe Jayle, Christophe Klein, Christophe Lancelin, Dan Angelescu, David Kaczmarek, Édouard Sage, Emmanuel Martinod, E Bréchet, Eric Roche, Eric Mensier, Florence De Dominicis, Florence Mazeres, Florent Charot, Françoise Le Pimpec‐Barthes, Gaetan Singier, Gilles Cardot, G Grosdidier, Guillaume Boddaert, Ilies Bouabdallah, Jacques Jougon, Jalal Assouad, Jean François Levi, Jean Marc Baste, Jean Michel Maury, J.-P. Arigon, Jean-Noël Choplain, Jean-Philippe Avaro, Jean‐Philippe Berthet, Jean-Philippe Le Rochais, Jocelyn Bellier, J Riviere, Karel Pfeuty, Laurence Solovei, Laurent Brouchet, Lotfi Benhamed, Lucia Mazzoni, L. Eraldi, Lucile Gust, Mădălina Grigoroiu, Maher Dabboussi, Marc Filaire, Marco Alifano, Marion Durand, Mathieu Coblence, Matthieu Péret, Mayeul Tabutin, Michel Alauzen, Myriam Ammi, Nicola Santelmo, Nicolas Vénissac, Nidal Alsit, Olaf Mercier, Olivier Aze, Olivier Hagry, Olivier N. Pagès, Olivier Tiffet, P. Thomas, Patrick Bagan, P. Boitet, Philippe Dalous, Philippe Kleinmann, Philippe Lacoste, Philippe Rinieri, Pierre Mordant
Abstract
OBJECTIVES: To determine safety and survival outcomes associated with lobectomy, segmentectomy and wedge resection for early-stage lung cancer by quiring the French population-based registry EPIdemiology in THORacic surgery (EPITHOR). METHODS: Retrospective analysis of 19 452 patients with stage c IA lung carcinoma who underwent lobectomy, segmentectomy or wedge resection between 2016 and 2022 with curative-intent. Main outcome measures were 90-day mortality and 5-year overall survival estimates. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patient, tumour and practice environment factors. RESULTS: The treatment distribution was 72.2% for lobectomy, 21.5% for segmentectomy and 6.3% for wedge. Unadjusted 90-day mortality rates were 1.6%, 1.2% and 1.1%, respectively (P = 0.10). Unadjusted 5-year overall survival estimates were 80%, 78% and 70%, with significant inter-group survival curves differences (P < 0.0001). Multivariable proportional hazards regression showed that wedge was associated with worse overall survival [adjusted hazard ratio (AHR), 1.23 (95% confidence interval 1.03-1.47); P = 0.021] compared with lobectomy, while no significant difference was disclosed when comparing segmentectomy to lobectomy (1.08 [0.97-1.20]; P = 0.162). The three-way propensity score analyses confirmed similar 90-day mortality rate for wedge resection and segmentectomy compared with lobectomy (hazard ratio: 0.43; 95% confidence interval 0.16-1.11; P = 0.081 and 0.99; 0.48-2.10; P = 0.998, respectively), but poorer overall survival (1.45; 1.13-1.86; P = 0.003 and 1.31; 1-1.71; P = 0.048, respectively). CONCLUSIONS: Wedge resection was associated with comparable 90-day mortality but lower overall survival when compared to lobectomy. Overall, all types of sublobar resections may not offer equivalent oncologic effectiveness in real-world settings.