Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a systematic review and meta-analysis

Abstract

Background: In recent years, many factors have revamped the interest in segmentectomies as preferred procedure for stage I non-small cell lung cancer (NSCLC). The aim of this systematic review and meta-analysis is to compare the outcomes of segmentectomy versus lobectomy regarding overall survival (OS) in the surgical treatment of stage I NSCLC, as stated in the conclusions of the largest studies conducted in this field and reported to date.

Methods: The searching strategy was developed in EMBASE, MEDLINE and Cochrane CENTRAL from 1990 until December 2016. The meta-analysis was performed with the combination of the reported survival outcomes of the individual studies using a random effect model. The OS of the lobectomy group was compared with the segmentectomy group alone. The hazard ratio (HR) and standard error were extracted or calculated for each study using the Kaplan-Meier method.

Results: Regarding the results, most of these studies were based on the retrospective data. The size of the cohorts varied from 17 to 11,520, with a total number of 24,542 patients. The pooled HR was 1.04 [95% confidence interval (CI), 0.92-1.18; P=0.50].

Conclusions: The survival in the segmentectomy group was not inferior to patients treated with lobectomy. In conclusion, the current meta-analysis disclosed that segmentectomies produce similar survival compared to lobectomy for patients with stage I NSCLC. To establish the role of segmentectomy in early NSCLC, more evidence is needed, in particular, a large numbered, prospective, randomised trials, which should dissolve the uncertainties and the questions raised by retrospective data.

Keywords: Lung cancer; hazard ratio (HR); lobectomy; meta-analysis; overall survival (OS); segmentectomy.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Summary of search strategy performed to identify relevant comparative studies on lobectomy versus segmentectomy for early stage not small cell lung cancer (PRISMA 2009 flow diagram). PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forest plot of HR for overall survival impact of operative approach (segmentectomy versus lobectomy) of stage I NSCLC patients. The pooled HR displayed in this figure when compared with segmentectomy suggested that there was not a significant benefit of lobectomy on HR of stage I patients (7-21) (HR 1.04; 95% CI, 0.92–1.18, P=0.50) (22-33). HR, hazard ratio; NSCLC, non-small cell lung cancer; CI, confidence interval; df, degree of freedom; SE, standard error.

Figure 3

Funnel plot of this analysis. This figure presents the publication bias (segmentectomy versus lobectomy in stage I NSCLC patients). NSCLC, non-small cell lung cancer.

Figure 4

Forest plot of hazard ratio for overall survival impact of operative approach (segmentectomy versus lobectomy) of stage I NSCLC patients in the retrospective studies of our analysis. NSCLC, non-small cell lung cancer.

Figure 5

Forest plot of hazard ratio for overall survival impact of operative approach (segmentectomy versus lobectomy) of stage I NSCLC patients in the randomized studies of our analysis. NSCLC, non-small cell lung cancer.