Table_3_Lobectomy versus segmentectomy for stage IA3 (T1cN0M0) non-small cell lung cancer: a meta-analysis and systematic review.doc

BackgroundSegmentectomy has been proven to have better survival and perioperative efficacy than lobectomy for non-small cell lung cancer (NSCLC) up to 2 cm. Whether this result is applicable to stage T1cN0M0 NSCLC (2.1 to 3 cm) remains controversial.MethodsWe conducted a comprehensive search across seven databases to identify relevant studies comparing lobectomy and segmentectomy procedures. Our primary focus was on survival indicators (overall survival [OS] and disease-free survival [DFS]), while for secondary outcomes, operative outcomes, hospitalization outcomes, recurrences, and complications were considered.ResultsAfter screening, the final analysis included 10 studies (involving 22113 patients in the lobectomy group and 1627 patients in the segmentectomy group). The lobectomy procedure achieved better OS (hazard ratio [HR]: 1.19 [1.07~1.33]) and DFS (HR: 1.37 [1.10~1.71]), which were proven in all subgroups. The OS rate at 2-5 years and DFS rate at 4-5 years were higher in the lobectomy group. The advantages of OS and DFS in the lobectomy group increased over the survival time. More lymph node dissections, intraoperative blood loss and total complications were found in the lobectomy group. Similar hospital stays, 90-day mortality and conversion thoracotomy were found between the two groups.ConclusionLobectomy appeared to be the better choice for patients with stage T1cN0M0 NSCLC with better survival (OS and DFS). However, the complications needed to be taken seriously.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identification CRD42023445013.

背景：背景肺段切除术已被证实相较于肺叶切除术，在治疗直径不超过2厘米的非小细胞肺癌（NSCLC）方面具有更佳的生存率和围手术期疗效。然而，该结果是否适用于T1cN0M0期NSCLC（直径为2.1至3厘米）仍然存在争议。方法：我们通过七个数据库的全面检索，确定了比较肺叶切除术与肺段切除术的相关研究。我们的主要关注点是生存指标（总生存期[OS]和无病生存期[DFS]），而对于次要结果，考虑了手术结果、住院结果、复发和并发症。结果：经过筛选，最终分析纳入了10项研究（包括肺叶切除术组的22113名患者和肺段切除术组的1627名患者）。肺叶切除术在所有亚组中均显示出更佳的OS（风险比[HR]：1.19[1.07~1.33]）和DFS（HR：1.37[1.10~1.71]），且这一结果得到了证实。肺叶切除术组的2-5年OS率和4-5年DFS率均高于肺段切除术组。OS和DFS的优势在生存期间逐渐增强。肺叶切除术组中发现了更多的淋巴结清扫、术中出血和总并发症。两组间的住院时间、90天死亡率以及开胸手术转换率相似。结论：对于T1cN0M0期NSCLC的患者，肺叶切除术似乎是更好的选择，具有更佳的生存率（OS和DFS）。然而，并发症需予以高度重视。系统评价注册号：https://www.crd.york.ac.uk/PROSPERO/，识别号CRD42023445013。