title: Stage I non-small-cell lung cancer: long-term results of lobectomy versus sublobar resection from the Polish National Lung Cancer Registry.
abstract: OBJECTIVE
  Anatomical lobar resection and mediastinal lymphadenectomy remain the standard for the treatment of early stage non-small-cell lung cancer (NSCLC) and are preferred over procedures such as segmentectomy or wedge resection. However, there is an ongoing debate concerning the influence of the extent of the resection on overall survival. The aim of this article was to assess the overall survival for different types of resection for Stage I NSCLC.
  
  
  METHODS
  We performed a retrospective analysis of the results of the surgical treatment of Stage I NSCLC. Between 1 January 2007 and 31 December 2013, the data from 6905 patients who underwent Stage I NSCLC operations were collected in the Polish National Lung Cancer Registry (PNLCR) and overall survival was assessed. A propensity score-matched analysis was used to compare 3 groups of patients, each consisting of 231 patients who underwent lobectomy, segmentectomy, or wedge resection.
  
  
  RESULTS
  In the unmatched and matched patient groups, lobectomy and segmentectomy were associated with a significant benefit compared to wedge resection regarding overall survival (log-rank P  < 0.001 and P  = 0.001). The Cox proportional hazard ratio comparing segmentectomy and lobectomy to wedge resection was 0.54 [95% confidence interval (CI): 0.37-0.77) and 0.44 (95% CI: 0.38-0.50), respectively, indicating a significant improvement in survival. There was no difference in the 5-year survival of patients after lobectomy (79.1%; 95% CI: 77.7-80.4%) or segmentectomy (78.3%; 95% CI: 70.6-86.0%). The 30-day mortality rate was 1.6, 2.6 and 1.4% for lobectomy, segmentectomy and wedge resection, respectively. Wedge resection was associated with a significantly lower 5-year survival rate (58.1%; 95% CI: 53.6-62.5%) compared to segmentectomy (78.3%; 95% CI: 70.6-86.0%) and lobectomy (79.1%; 95% CI: 77.7-80.5%). The propensity score matched analysis confirmed most of the results of the comparisons of unmatched study groups.
  
  
  CONCLUSIONS
  Wedge resection was associated with significantly lower 3-year and 5-year survival rates compared to the other methods of resection. There was no significant difference in 3-year or 5-year survival rates between lobectomy and segmentectomy. Segmentectomy, but not wedge resection, could be considered an alternative to lobectomy in the treatment of patients with Stage I NSCLC.
authors.affiliation: Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Dziedzic
authors.affiliation: Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zurek
authors.affiliation: Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Marjanski
authors.affiliation: Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Rudzinski
authors.affiliation: Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland.
authors.forename: Tadeusz M
authors.initials: TM
authors.lastname: Orlowski
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Wioletta
authors.initials: W
authors.lastname: Sawicka
authors.affiliation: Data Mining Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Marczyk
authors.affiliation: Data Mining Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Polanska
authors.affiliation: Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Rzyman
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies
keywords: Lobectomy; Lung cancer ; Segmentectomy; Sublobar resection; Wedge resection