Pneumonectomy has been the main treatment for resectable lung cancer in the past 20 years (20-21). Since the introduction of lobectomy in the late 1950s, it has become the surgical treatment of choice for patients with early NSCLC, with reduced morbidity and mortality, and the observed long-term survival after 5 years (22).
Surgery should not only be completely removed, but also have a good quality of life. Surgical treatment of patients may not be common, as evidence suggests that elderly patients with early NSCLC or patients who are intolerant to lobectomy due to poor cardiopulmonary reserve and multiple comorbidities may be beneficial for segmentectomy (19).
In addition, the JCOG team has conducted several promising RCTs to test the effectiveness of segmentectomy to determine if segmentectomy can be a suitable alternative to early stage lung cancer (23-24).
This meta-analysis failed to report a better segmentectomy than lobectomy, and the results were similar between the two groups in terms of OS and LCSS.
To the best of our knowledge, some trials have reported that an in vitro physician's decision and/or patient-related factors may influence the choice of surgery. Preoperative clinical factors may have an impact on the decision to perform accurate mediastinal LN resection, such as clinical stage, patient age, and limited resection.
A study by Smith et al. (25) showed that, based on surveillance, epidemiology and final outcome (SEER) - Medicare registration, segmental resection should be an alternative treatment for limited resection of patients with stage NS NSCLC.
In the Veluswamy study, the study reported differences in elderly patients with different histological subgroups (26). Conversely, for younger patients, resected lobectomy and lobectomy are preferred. Cao's meta-analysis suggests that “intentional selection” and “compromise” may influence the difference in prognosis between the two surgical approaches (27). Lungectomy can be chosen for young patients, and for older patients, resection should be more appropriate.
In addition, patients undergoing complete LN staging are considered to have a good clinical status, so lobectomy is planned. However, patients with poor medical conditions are more likely to be scheduled for a segmentectomy, which may result in laminectomy with comparable OS and LCSS and lobectomy in both.
Therefore, unbalanced baseline characteristics may result in false positive results. Since the number of LNs examined depends on the pathology report, further RCTs need to focus on the effect of the regional LN range on the difference in prognosis between the two surgical treatments (28).
In addition, due to the retrospective nature of all included studies, imbalances in baseline demographic and clinical characteristics, prejudice still exists, which may affect the comparison of outcomes of interest. Therefore, it shows that better design studies have stronger statistical power, which is essential for comparing the survival outcomes of segmentectomy and lobectomy.