ObjectiveTo compare the efficacy of anatomic segmentectomy combined with adjacent segmentectomy versus segmentectomy combined with extended wedge resection for deeply-located intersegmental early-stage non-small cell lung cancer (NSCLC) with a diameter≤2 cm. MethodsA retrospective analysis was conducted on the patients with deep intersegmental early-stage NSCLC (≤2 cm) who underwent sublobar resection at Nanjing Chest Hospital from March 2019 to November 2024. Preoperative three-dimensional reconstruction was performed to localize nodules and plan resection margins. Patients were divided into an anatomic group (undergoing segmentectomy with adjacent segmentectomy) and an extended group (undergoing segmentectomy with extended wedge resection). Perioperative outcomes and long-term survival of two groups were compared. ResultsA total of 95 patients were collected. Among them, there were 38 males and 57 females, aged 32 to 78 years. There were 57 patients in the anatomic group, and 38 patients in the extended group. All operations were successfully completed. Compared with the extended group, the anatomic group had a significantly lower intraoperative complication rate (0.0% vs. 10.5%, P=0.023), earlier chest tube removal [(3.05±1.64) d vs. (3.82±1.41) d, P=0.021], and shorter postoperative hospital stay [(4.23±1.73) d vs. (5.21±1.51) d, P=0.021]. There were no statistical differences between the two groups in terms of intraoperative blood loss, operative time, or postoperative complication rates (all P>0.05). The surgical margin width was significantly greater in the anatomic group than in the extended group (2.34 cm vs. 1.60 cm, P<0.001). No significant differences were observed in tumor size, number of lymph nodes dissected, number of lymph node stations, histological type, or pathological stage between the two groups (all P>0.05). With a median follow-up of 28 months, the local recurrence rate was significantly higher in the extended group (15.8%, 6/38) compared to the anatomic group (1.8%, 1/57) (P=0.015), with all recurrences in the extended group occurring at the surgical margin, while only one regional lymph node recurrence occurring in the anatomic group. There were no statistical differences in estimated 5-year disease-free survival rate (78.5% vs. 76.7%, P=0.200) or estimated overall survival rate (91.2% vs. 81.2%, P=0.980) between the two groups. ConclusionFor deeply-located intersegmental early-stage NSCLC≤2 cm, anatomic segmentectomy with adjacent segmentectomy offers superior intraoperative safety, faster postoperative recovery, lower local recurrence, and wider margins compared to segmentectomy with extended wedge resection, making it a preferable surgical approach.
