88. Lobectomy Is Not Associated with Improved Survival Over Segmentectomy in Node Positive Non-Small Cell Lung Cancer: A National Cancer Database Analysis
William Michael Whited, Mickey S. Ising, Jaimin R. Trivedi, Victor van Berkel, Matthew P. Fox
University of Louisville, Louisville, KY
Invited Discussant: Richard Battasarano
Objective: In patients with early stage non-small cell lung cancer (NSCLC), most surgeons view regional lymph node (N1) involvement as a relative contraindication to sublobar resection. The purpose of this study was to investigate if there was a survival advantage associated with lobectomy in patients with T1N1 disease.
Methods: The National Cancer Database (NCDB) was queried for patients undergoing resection for T1 (< 3 cm) NSCLC (excluding sarcomatoid and neuroendocrine histology) with pathologic peribronchial, hilar or intrapulmonary lymph node involvement (N1) from 2006 to 2014. Patients with mediastinal lymph node involvement or metastatic disease were excluded from the analysis. Patients were analyzed by type of resection received (lobectomy or segmentectomy) (Table 1). Survival was calculated for propensity matched groups of those undergoing lobectomy vs segmentectomy using the Kaplan-Meier method.
Results: After the inclusion and exclusion criteria were applied, a total of 6362 were included in the analysis. A total of 6210 patients underwent lobectomy and 152 underwent segmentectomy. In propensity matched groups of patients undergoing a R0 resection with T1N1 NSCLC, there was found to be no difference in overall survival between segmentectomy vs lobectomy (Figure 1; p-value: 0.655). The 1, 3 and 5-year survival for segmentectomy and lobectomy groups was (96%, 69% and 32%) and (98%, 68% and 37%) respectively.
Conclusions:In patients undergoing resection for small (T1) NSCLC who ultimately are found to have peribronchial, hilar or intrapulmonary lymph node involvement (N1), there does not appear to be an overall survival advantage for lobectomy over segmentectomy.