ArticleJournal of thoracic disease2025
Does surgical margin affect recurrence and survival after pulmonary segmentectomy for cT1 lung cancer?
Article in Journal of thoracic disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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7 authors.
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Abstract
Background: During segmentectomy for early-stage non-small cell lung cancer (NSCLC), it is advised that the tumor be at least 1 cm away from the intersegmental plane, with a margin-to-tumor (M/T) ratio of at least 1. This study aims to investigate how surgical margin influences the risk of recurrence and overall survival (OS) following pulmonary segmentectomy. Methods: This is a single-center study including consecutive patients who underwent pulmonary segmentectomy for cT1N0M0 NSCLC between January 2017 and December 2022. Surgical margin distance and M/T ratio were measured on deflated lung specimens and analyzed as predictors of recurrence-free survival (RFS) and OS. Results: In total, 291 patients (median age: 69 years) underwent segmentectomy for cT1a (n=65), cT1b (n=152) and cT1c (n=74) cN0 NSCLC. Surgical approach was performed by video-assisted thoracoscopic surgery in 99% and conversion thoracotomy was necessary in 2.4%. Single segmentectomy was performed in 183 patients (63%). The median number of dissected lymph nodes was 7 [interquartile range (IQR), 4-12]. The median size of tumor was 15 (IQR, 11-20) mm. The median surgical margin was 13 (IQR, 7-22) mm and 32% of patients had surgical margin of less than 10 mm with only one patient with R1 resection. M/T ratio >1 was achieved in 49%. Nodal upstaging was found in 14 patients (5%). During the follow-up, 63 patients (21%) were lost and removed from analyses. Local recurrence was observed in only 3 patients (1%) and distant in 19 patients (8%). RFS was significantly associated with positron emission tomography (PET) fluorodeoxyglucose (FDG) uptake >3 [hazard ratio (HR) =4.89], pleural invasion (HR =3.02) and nodal upstaging (HR =3.79). However, surgical margin <10 mm or ratio <1 were not correlated with increased local recurrence (HR =0.78; P=0.62) (HR =0.69; P=0.40) or poorer survival (HR =1.14; P=0.81) (HR =1.73; P=0.31), respectively. Conclusions: Local recurrence remains infrequent after pulmonary segmentectomy for cT1N0 NSCLC even after limited surgical margin.
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