Impact of segmentectomy on treatment for secondary malignancies and other causes of death after lung cancer surgery.

Objective: Deaths not associated with primary lung cancer (other deaths) and secondary malignancies affect long-term survival after surgery for early-stage non-small cell lung cancer. The JCOG0802 trial suggested that segmentectomy may lower the risk of such deaths. This study examined the relationship between the incidence of other deaths and surgical procedures. Methods: This retrospective, single-center study included patients with clinical stage 0 or IA non-small cell lung cancer who underwent segmentectomy or lobectomy between 2013 and 2016. Other deaths were defined as deaths from causes unrelated to the original lung cancer. Guideline-concordant treatment was assessed based on the National Comprehensive Cancer Network Guidelines. Results: The 5-year overall survival was 90.7%, with a median follow-up of 5.6 years. Among 122 total deaths, 51 (41.8%) were other deaths. Segmentectomy (n = 241) was associated with a lower rate of other deaths (2.5% vs 5.9%) than lobectomy (n = 758), including deaths from other malignancies (1.2% vs 2.6%) and nonmalignancy-related deaths (1.2% vs 3.3%). These findings remained consistent after adjusting for patient characteristic imbalances between the groups. Further, the rate of guideline-concordant treatment for secondary malignancies was higher in the segmentectomy group than in the lobectomy group (71.4% vs 63.8%), with a 9.8% higher rate for second primary lung cancer. Conclusions: Segmentectomy was associated with a lower incidence of deaths not associated with primary lung cancer than lobectomy. The higher rate of guideline-concordant treatment for secondary malignancies in the segmentectomy group may partially explain the reduced incidence of deaths from secondary malignancies.