Peripheral small-size lung cancer is increasingly treated by sublobar resection. Because segmentectomy is less intrusive than lobectomy and provides greater local control than wedge resections, it has emerged as a viable therapeutic choice among sublobar resection procedures. Segmentectomy outperformed lobectomy in terms of overall survival (OS) for patients with small-size non-small cell lung cancer (NSCLC), according to a large prospective randomized study.
The fact that segmentectomy is less intrusive than lobectomy may be one explanation for this finding. Low muscle mass, or sarcopenia, is now well acknowledged as a risk factor for a worse prognosis in a variety of benign and malignant diseases. In several cancer types, preoperative sarcopenia has been linked to postoperative prognoses.
Little is known about how segmentectomy and lobectomy affect the postoperative results of patients with low muscle mass, despite the fact that segmentectomy is less intrusive than lobectomy. The postoperative prognosis of patients with non-small cell lung cancer was investigated in this study based on the kind of surgery and preoperative muscle mass.
This investigation included data from patients who had lobectomies or segmentectomies for early-stage non-small cell lung cancer between 2010 and 2020 with solid-dominant tumors up to 2 cm in size or ground glass opacity-dominant tumors up to 3 cm in size were retrospectively evaluated. The height-adjusted erector spinae muscle mass on preoperative chest computed CT images was used to calculate the preoperative muscle mass. Individuals with low and high muscle mass in the lobectomy and segmentectomy groups had different overall survival rates.
Nearly, 371 individuals were recruited in the research, 209 of whom had segmentectomy and 162 of whom had lobectomy. In the lobectomy group, patients with low muscle mass had a considerably worse 5-year overall survival than those with high muscle mass; however, in the segmentectomy group, there was no discernible difference.
Low muscle mass was an independent predictive factor in the lobectomy group but not in the segmentectomy group in the various multivariable models. Overall, in terms of mortality from other causes, segmentectomies were more likely to be beneficial than lobectomies for individuals with poor muscle mass who are considered to be at risk.
Source:
Ueda, D., Mimae, T., Kamigaichi, A., Tsubokawa, N., Miyata, Y., Yoshimura, K., & Okada, M. (2025). Prognostic benefit of segmentectomy for patients with low muscle mass in early-stage lung cancer. Annals of Surgical Oncology. https://doi.org/10.1245/s10434-024-16384-5
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