Limited resection for stage IA radiologically invasive lung cancer: A real-world nationwide database study

Junichi Soh, Shinichi Toyooka, Yasushi Shintani, Jiro Okami, Hiroyuki Ito, Takashi Ohtsuka, Takeshi Mori, Shun Ichi Watanabe, Hisao Asamura, Masayuki Chida, Shunsuke Endo, Ryoichi Nakanishi, Mitsutaka Kadokura, Hidemi Suzuki, Etsuo Miyaoka, Ichiro Yoshino, Hiroshi Date

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


OBJECTIVES: Radiologically invasive non-small-cell lung cancer, defined as consolidation size to maximum tumour diameter ratio of over 0.5, is associated with pathological invasiveness and worse prognosis. However, there are no real-world, nationwide database studies on limited resections that consider radiological invasiveness. This study aimed to investigate the prognostic validity of limited resection, such as segmentectomy and wedge resection, in cStage IA (TNM 8th edition) radiologically invasive lung cancer. METHODS: We conducted a retrospective analysis of patients who underwent complete resection according to the Japanese Joint Committee of Lung Cancer Registry Database. The relationship between surgical procedures and prognosis was examined using stratification by cT factor and radiological invasiveness. RESULTS: Among the 5,692 patients enrolled, lobectomy, segmentectomy and wedge resection were performed in 4,323 (80.0%), 657 (11.5%) and 712 (12.5%) patients, respectively. Multivariable analysis with or without propensity score matching indicated that older age, poor performance status and wedge resection were significantly associated with worse prognosis and that patients who underwent segmentectomy showed an equivalent prognosis to those who underwent lobectomy. Subset analyses revealed that segmentectomy showed an equivalent prognosis to lobectomy in patients with cT1b or less, but not in those with cT1c, especially for non-pure radiological invasive cT1c; 5-year overall survival rates were 91.4% vs 90.4% in cT1b with non-pure radiological invasiveness and 80.0% vs 83.8% in cT1b with pure radiological invasiveness, respectively. CONCLUSIONS: Segmentectomy can be an alternative to lobectomy in patients with radiologically invasive lung cancer with cT1b or less but not in those with cT1c.

Original languageEnglish
Article numberezac342
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number1
Publication statusPublished - 2022 Jul 1


  • Limited resection
  • Nationwide database study
  • Non-small-cell lung cancer
  • Segmentectomy
  • Sublobar resection
  • Wedge resection

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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