title: Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer.
abstract: BACKGROUND
  Survival difference following lobectomy, segmentectomy, and wedge resection in stage I non-small cell lung cancer (NSCLC) and its subgroups remains undetermined.
  
  
  METHODS
  We systemically searched published articles comparing recurrence-free survival (RFS), overall survival (OS), or cancer-specific survival (CSS) between lobectomy and limited resection or between segmentectomy and wedge resection.
  
  
  RESULTS
  A total of 42 studies published from 1980 to 2014 enrolling 21,926 patients were included in this meta-analysis. Survival results favored lobectomy in stage IA NSCLC ≤2 cm (combined HR: 1.530, 95% CI: 1.402-1.671, P < 0.001) or patient's ≥65 years old (combined HR: 1.227, 95% CI: 1.003-1.502, P = 0.047). Survival outcome of video-assisted thoracoscopic (VATS) sublobectomy was comparable to that of VATS lobectomy (pooled HR: 0.808, 95% CI: 0.556-1.174, P = 0.263). The combined HR of segmentectomy versus lobectomy was 1.231 (95% CI: 1.070-1.417, P = 0.004), while the pooled HR of wedge resection versus segmentectomy was 1.542 (95% CI: 0.856-2.780, P = 0.149).
  
  
  CONCLUSIONS
  This study suggested that tumor size or age alone should not be the criteria to encourage sublobar resection. For stage I NSCLC, survival following segmentectomy was inferior to lobectomy. Patients undergoing intentional sublobectomy achieved comparable survival as those who received lobectomy.
authors.affiliation: Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yihua
authors.initials: Y
authors.lastname: Sun
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Ting
authors.initials: T
authors.lastname: Ye
authors.forename: Yiliang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Haiquan
authors.initials: H
authors.lastname: Chen
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate
keywords: carcinoma; lobectomy; meta-analysis; non-small-cell lung; segmentectomy; stage I; wedge resection