Comparison of segmentectomy and lobectomy for non-small cell lung cancer with visceral pleural invasion

Comparison of segmentectomy and lobectomy for non-small cell lung cancer with visceral pleural invasion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of segmentectomy and lobectomy for non-small cell lung cancer with visceral pleural invasion Masaya Tamura, Takashi Sakai, Naoki Furukawa, Yujiro Bunno, Marino Yamamoto, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6631641/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 15 You are reading this latest preprint version Abstract Background Visceral pleural invasion (VPI) is known to have a significant impact on staging and prognosis in NSCLC and is an important factor in determining surgical strategy. The aim of this study was to compare the outcomes of surgical procedure (segmentectomy vs lobectomy) with VPI positive patients. Methods A retrospective study was conducted on 218 VPI positive NSCLC patients were studied, with the segmentetomy group (n = 42) designated as cohort.1, cases with tumor diameter less than 2 cm (n = 22) designated as cohort.2, and cases with greater than 2 cm (n = 20) designated as cohort.3. Each group and 150 cases of lung lobectomy were analyzed. Cause of death and recurrence mode were investigated. Results There was no difference in OS, DSS and RFS between segmentectomy and lobectomy after propensity matched analysis. There was no difference in OS and RFS in the group of cases 2 cm, there was a trend toward a better prognosis for lobectomy compared to segmentectomy in terms of RFS (p = 0.08). There was no difference in lung cancer deaths, but there was a trend toward more deaths from multiple disease in the lobectomy group (p = 0.07), and pleural dissemination recurrence was significantly more common in the segmentectomy group than in the lobectomy group in the > 2 cm group (p = 0.03). Conclusion In patients with VPI positive lung cancer, segmentectomy may offer a better prognosis for those with tumors measuring 2 cm. non-small cell lung cancer (NSCLC) visceral pleural invasion (VPI) segmentectomy prognosis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Surgical resection is currently the mainstay of curative treatment for early-stage non-small cell lung cancer (NSCLC). Visceral pleural invasion (VPI) has a significant impact on staging and prognosis and is an important factor in determining surgical strategy [ 1 , 2 ]. Previous studies demonstrated that NSCLC patients with VPI have more progressive tumors and are at an increased risk of mediastinal lymph node metastasis [ 3 , 4 ] and recurrence [ 5 ]. Therefore, lobectomy, which allows more adequate resection, has been considered the standard technique [ 6 ]. Nevertheless, segmentectomy is increasingly indicated for the preservation of pulmonary function, particularly in elderly patients and those with comorbidities. It was recently suggested that segmentectomy provides a comparable prognosis to that associated with lobectomy in patients with small tumors [ 7 ], and its appropriateness is also being examined in patients with pleural involvement. However, there is limited evidence on the prognostic comparison of segmentectomy versus lobectomy in NSCLC with VPI. Moreover, there is no clear consensus on the impact of tumor size on surgical selection and prognosis. The impact of resection technique on the recurrence pattern and cause of death has also not been fully investigated. In the present study, we retrospectively analyzed the effect of tumor size and surgical technique on prognosis, recurrence pattern, and cause of death in patients with NSCLC with pleural invasion. In particular, we aimed to gain insight into future treatment strategies by comparing the outcomes of segmentectomy and lobectomy in two groups of patients with tumor diameters measuring 2 cm. Materials and Methods Patient population The internal review board (ERB-111369) at our hospital approved this study. Overall, 922 patients with NSCLC who underwent curative lung resection from 2012 to 2022 were included in the present investigation. Of those, 218 patients with VPI were evaluated (Fig. 1 ). Patients who underwent segmentectomy (n = 42) were classified into cohort 1; those with tumors measuring 2 cm (n = 20) were classified into cohort 2 and cohort 3, respectively. These patients as well as 150 patients who underwent lobectomy were analyzed; subsequently, cohort 1 (n = 38), cohort 2 (n = 22), and cohort 3 (n = 20) were background-matched by the grade of VPI, tumor size, age, sex, histology, and pathological nodal stage. Table 1 shows the background of the 42 and 150 patients who underwent segmentectomy and lobectomy, respectively. Table 2 shows the patient background after propensity score matching (PSM). Table 1 Characteristics of patients undergoing segmentectomy or lobectomy. Factors Segment resection (n = 42) Lobar resection (n = 150) p value Gender 0.59 Male 30 103 Female 12 47 Age 0.24 < 72 years 20 77 ≥ 72 years 22 73 Lesion size < 0.0001 < 3.1cm 31 60 ≥ 3.1cm 11 90 Histology 0.46 Non adenoca 16 53 Adenoca 26 97 Pathological stage 0.01 IB 23 57 IIA 2 9 IIB 6 33 IIIA 7 38 IIB 4 13 Pathological Nodal Stage 0.11 N0 30 98 N1 6 17 N2 6 35 Pleural invasion 0.09 pl1 22 83 pl2 12 29 pl3 8 38 Table 2 Patient characteristics of propensity score matched cohort. Factors Sublobar resection (n = 38) Lobar resection (n = 38) p value Gender 0.32 Male 28 24 Female 10 14 Age 0.91 < 72 years 18 19 ≥ 72 years 20 19 Lesion size 0.79 < 3.1cm 28 29 ≥ 3.1cm 10 9 Histology 0.41 Non adenoca 14 11 Adenoca 24 27 Pathological stage 0.72 IB 24 25 IIA 1 1 IIB 5 2 IIIA 7 9 IIB 1 1 Pathological Nodal Stage 0.52 N0 28 26 N1 5 4 N2 5 8 Pleural invasion 0.86 pl1 22 24 pl2 11 9 pl3 5 5 Patient outcomes and follow-up Standard follow-up for patients included chest computed tomography scans, physical examinations, and blood tests that were conducted every 3–6 months for the first 3 years following the procedure, and every 6–12 months thereafter. 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging were also performed when necessary. Median duration of follow-up in our study was 54 months (mean: 49.2; range: 24–134 months). The primary outcome was recurrence-free survival (RFS), defined as the period of time from initial surgical resection to the first evidence of recurrence. Lesion imaging and physical examinations were used to diagnose tumor recurrence. Histological confirmation of the diagnosis was also performed when it was clinically feasible. Statistics The associations between clinical outcomes and imaging and clinical metrics were evaluated using multivariate and univariate Cox proportional hazards regression models. The 95% confidence intervals were calculated, and the percentages were two-sided. For continuous variables, presented as the mean ± standard deviation, the student’s t -test was employed to assess significant differences. For categorical variables, the chi-squared test was utilized to assess statistical significance. The SAS software package (SAS Institute, Inc., Cary, NC, USA) was used for statistical analyses. The p-values < 0.05 indicate statistically significant differences. Results Figure 2 shows the overall survival (OS), disease-specific survival, and RFS associated with each procedure in cohort 1. No statistically significant difference was found between the two groups (p = 0.24, 0.34, and 0.88, respectively). Figure 3 shows the OS, disease-specific survival, and RFS linked to each procedure after PSM in cohort 1. No statistically significant difference was found between the two groups (p = 0.47, 0.46, and 0.69, respectively). Figure 4 shows the OS and RFS following each procedure after PSM in cohort 2; similarly, no difference was found between the two groups (p = 0.17 and 0.94, respectively). Figure 5 shows the OS and RFS after each surgical procedure in the group of patients with tumors measuring > 2 cm (cohort 3). Results indicated that the RFS was better in the lobectomy group compared with the segmentectomy group, although the difference was not statistically significant (p = 0.08). Table 3 shows the causes of death according to each procedure after PSM. There was no difference between the groups in the rate of deaths related to lung cancer; however, there was a trend toward more deaths from other diseases in the lobectomy group versus the segmentectomy group. Table 4 shows the recurrence patterns after each procedure in the patients with tumors measuring > 2 cm. The segmentectomy group had a significantly higher rate of pleural dissemination recurrence than the lobectomy group. Table 3 Summary of causes of death during follow-up. Segmentectomy (n = 38) Lobectomy (n = 38) p value Alive 28 (73.7%) 24 (63.1%) Cause of death lung cancer 6 (15.8%) 5 (13.2%) Other 4 (10.5%) 9 (23.7%) 0.07 other cancer 2 pneumonia 3 2 IP 1 1 AMI 1 Renal failure 1 pulmonary embolism 1 hypoglycemic attack 1 IP: interstitial pneumonia AMI: acute myocardial infarction Table 4 Recurrence pattern by surgical procedure after propensity matched analysis. Segmentectomy (n = 20) Lobectomy (n = 60) p value None 11 (55.0%) 43 (71.7%) Mode of recurrence Loco-regional 1 (5.0%) 5 (8.3%) Dissemination 4 (20.0%) 3 (5.0%) 0.03 Distant 4 (20.0%) 9 (15.0%) Discussion In the present study, we investigated the relationship between tumor size and surgical technique and its impact on prognosis in the surgical treatment of NSCLC with VPI. The results showed that in patients with tumors measuring 2 cm. These findings may be useful in reconsidering the indications for reduction surgery in patients with pleural invasion. Pleural involvement is an important factor in the staging of early-stage NSCLC. The International Association for the Study of Lung Cancer has recognized the importance of VPI for up-staging in the 7th edition of the NSCLC staging system and incorporated it into the tumor-node-metastasis (TNM) staging system [ 8 ]. Subsequent studies have revealed that VPI is linked to poor prognosis in patients with early-stage NSCLC, and the PL classification has been reconsidered for inclusion in the 8th edition of the TNM staging system [ 9 ]. Several investigations, including the Japan Clinical Oncology Group 0802 study, have demonstrated the safety and effectiveness of segmental resection with hilar and mediastinal lymph node dissection in patients with early-stage NSCLC and tumors measuring ≤ 2 cm [ 7 , 10 ]. Regarding the prognosis of early-stage lung cancer with VPI, the 5-year survival rates of patients with stage IB NSCLC who underwent surgical reduction or lobectomy were comparable [ 11 ]. Nonetheless, Yu et al. [ 12 ] showed that patients with tumors measuring 80 years) with clinical stage I lung cancer even if the tumor is VPI-positive [ 13 ]. Several recent studies have reported reduced resection with VPI as the primary focus and lobectomy [ 13 , 14 , 15 ]; however, the appropriate surgical treatment remains controversial. In patients with tumors measuring < 2 cm, the local spread of the tumor is relatively low, and even with pleural invasion, the tumor is likely to be confined to the area; thus, zonal resection may provide adequate local control. In addition, zonal resection may be a useful option, especially for elderly patients or those with impaired respiratory function, because it is superior in preserving lung function, improves postoperative quality of life, and reduces the risk of other diseases. Nevertheless, if the tumor measures > 2 cm, it is likely to have more advanced pleural involvement, and there is a risk that a regional resection may be inadequate in terms of microinvasion and spread to adjacent areas. Lobectomy allows for more extensive lymph node dissection and local control, which may improve prognosis. In the present study, the frequency of pleural seeding recurrence was higher after segmentectomy compared to lobectomy, presumably due to the influence of resection margins and peritumoral pathology. These findings also suggest that lobectomy is superior in terms of tumor control in patients with tumors measuring > 2 cm, whereas lobectomy is not necessary in those with tumors measuring < 2 cm simply because they are VPI-positive. The higher incidence of death from other causes in the lobectomy group may be due to the more invasive nature of the procedure, decreased pulmonary function after the procedure, and systemic risks derived from patient background. Therefore, it is important to construct an individualized treatment strategy that takes into account tumor factors and the general condition of the patient, as well as the presence or absence of complications when selecting a surgical approach; furthermore, a detailed analysis of risk factors is necessary. According to the evidence, in NSCLC patients with pleural invasion, regional resection may be a safe and effective option for those with tumors measuring 2 cm. Moreover, the degree of pleural involvement (PL1, PL2, and PL3) has been reported to affect prognosis [ 9 ]. PL1, PL2, and PL3 refer to involvement beyond the elastic layer, pleural surface, and all layers of the pleura, respectively, and prognosis tends to worsen as the degree of involvement progresses. In the present study, PL positivity was examined collectively, studies in the future should include subgroup analysis by the degree of PL. This study had several limitations. Firstly, this is a retrospective, single-center investigation with a limited number of cases. Secondly, regarding the type of resection, limited resection was performed for high-risk patients, whereas lobectomy was more desirable. Conclusions In patients with VPI-positive lung cancer, segmentectomy may offer a better prognosis than lobectomy for those with tumors measuring 2 cm. A balance between local control of the tumor and preservation of pulmonary function should be considered when selecting a surgical approach. Prospective studies are warranted to establish optimal treatment strategies for this disease. Abbreviations non-small cell lung cancer (NSCLC) visceral pleural invasion (VPI) propensity score matching (PMA) computed tomography (CT) fluorodeoxyglucose positron emission tomography (FDG-PET) recurrence-free survival (RFS) overall survival (OS) disease specific survival (DSS) International Association for the Study of Lung Cancer (IASLC) Japan clinical oncology group (JCOG) Declarations Ethical Approval and Consent to participate This study was approved by our hospital’s internal review board (ERB-111369). Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor- in- chief of this journal. Availability of supporting data Not applicable Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors ’ contributions TS, NF, YB, MY, RM, HO analyzed and interpreted the patient data. MT performed the literature review and was a major contributor in writing the manuscript. MT and HO performed the final editing of the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable References Fibla JJ, Cassivi SD, Brunelli A, Decker PA, Allen MS, Darling GE, et al. Re-evaluation of the prognostic value of visceral pleura invasion in Stage IB non-small cell lung cancer using the prospective multicenter ACOSOG Z0030 trial data set. Lung Cancer. Dec; 2012;78(3):259–62. 10.1016/j.lungcan.2012.09.010 . Epub 2012 Oct 3. Osaki T, Nagashima A, Yoshimatsu T, Yamada S, Yasumoto K. Visceral pleural involvement in non-small cell lung cancer: prognostic significance. Ann Thorac Surg. 2004;77(5):1769–73. 10.1016/j.athoracsur.2003.10.058 . Shimizu K, Yoshida J, Nagai K, Nishimura M, Ishii G, Morishita Y, Nishiwaki Y. Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. 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The prognosis of small-sized non-small cell lung cancer with visceral pleural invasion after sublobar resection. Transl Cancer Res. 2020;9(10):6431–43. 10.21037/tcr-20-1995 . Yu Y, Huang R, Wang P, Wang S, Ling X, Zhang P, et al. Sublobectomy versus lobectomy for long-term survival outcomes of early-stage non-small cell cancer with a tumor size less than 2cm accompanied by visceral pleural invasion: a SEER population-based study. J Thorac Dis. Mar; 2020;12(3):592–604. 10.21037/jtd.2019.12.121 . Li S, Ge Y, Ma R, Wang J, Ma T, Sun T, et al. Comparison of wedge resection and anatomical lung resection in elderly patients with early-stage non-small cell lung cancer with visceral pleural invasion: a population-based study. Thorac Cancer. Feb; 2025;16(3):e15532. 10.1111/1759-7714.15532 . Whitehorn GL, Rshaidat H, Madeka I, Martin J, Mack SJ, Meredith L, et al. Lobectomy is not associated with improved survival as compared to segmentectomy in early-stage lung cancer patients with visceral pleural invasion. Clin Lung Cancer. 2025;26(2):e99–107. e10. Epub 2024 Nov 18. Mathey-Andrews C, Abruzzo AR, Venkateswaran S, Potter AL, Senthil P, Beqari J, et al. Segmentectomy vs lobectomy for early non-small cell lung cancer with visceral pleural invasion. Ann Thorac Surg. May; 2024;117(5):1007–14. Epub 2023 Jul 5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 16 Sep, 2025 Reviews received at journal 17 Jul, 2025 Reviews received at journal 15 Jul, 2025 Reviews received at journal 10 Jul, 2025 Reviewers agreed at journal 10 Jul, 2025 Reviewers agreed at journal 10 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviews received at journal 09 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers invited by journal 09 Jul, 2025 Editor assigned by journal 12 May, 2025 Submission checks completed at journal 12 May, 2025 First submitted to journal 09 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6631641","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":483594401,"identity":"b0ac423c-d637-484d-8df9-801234754f0b","order_by":0,"name":"Masaya Tamura","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDADfh4GBmYGAyhPgpDyA0As2UOyFoMzIC3EAN324w8/f6jZlrj5zOGDnwsKGBIb2A8/YLDcgVuL2ZkcY4kDx24nbjvbliw9wwCohSfNgEHyDB4tB3IYJA6wAbWc5zFj5jH4n9jAkAP0WRseLeefP/5x4N/txM39YC1AW/jfENByI8FM4mDb7cQNvD1QLRKEbLnxxszibN9t4xlnjiVLA7UYt0k8MziA1y/n0x/fqPh2W7a/J/ngZ54/DLL9/MkPH0viCTFMwAbEhyUbSNECAowfSdYyCkbBKBgFwxgAAJSLUyjYKN7PAAAAAElFTkSuQmCC","orcid":"","institution":"Kochi Medical School","correspondingAuthor":true,"prefix":"","firstName":"Masaya","middleName":"","lastName":"Tamura","suffix":""},{"id":483594408,"identity":"b2cdd8aa-6dbf-4e0d-8a3b-bcc886082745","order_by":1,"name":"Takashi Sakai","email":"","orcid":"","institution":"Kochi Medical School","correspondingAuthor":false,"prefix":"","firstName":"Takashi","middleName":"","lastName":"Sakai","suffix":""},{"id":483594412,"identity":"5a4dd452-7276-4b5c-bb36-a4dcc608b66a","order_by":2,"name":"Naoki Furukawa","email":"","orcid":"","institution":"Kochi Medical School","correspondingAuthor":false,"prefix":"","firstName":"Naoki","middleName":"","lastName":"Furukawa","suffix":""},{"id":483594414,"identity":"95b04dec-98d0-42d9-8092-9b2d9b48a444","order_by":3,"name":"Yujiro Bunno","email":"","orcid":"","institution":"Kochi Medical School","correspondingAuthor":false,"prefix":"","firstName":"Yujiro","middleName":"","lastName":"Bunno","suffix":""},{"id":483594416,"identity":"f40f49ff-1d23-49b5-a530-1a0d156d21ab","order_by":4,"name":"Marino Yamamoto","email":"","orcid":"","institution":"Kochi Medical School","correspondingAuthor":false,"prefix":"","firstName":"Marino","middleName":"","lastName":"Yamamoto","suffix":""},{"id":483594418,"identity":"5e80a599-bff0-49af-bae2-226a153e1fe2","order_by":5,"name":"Ryohei Miyazaki","email":"","orcid":"","institution":"Kochi Medical School","correspondingAuthor":false,"prefix":"","firstName":"Ryohei","middleName":"","lastName":"Miyazaki","suffix":""},{"id":483594422,"identity":"03a2ddb0-6f8b-4f8a-9133-ef8ad48186e0","order_by":6,"name":"Hironobu Okada","email":"","orcid":"","institution":"Kochi Medical School","correspondingAuthor":false,"prefix":"","firstName":"Hironobu","middleName":"","lastName":"Okada","suffix":""}],"badges":[],"createdAt":"2025-05-09 23:38:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6631641/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6631641/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-025-03715-0","type":"published","date":"2025-12-24T15:58:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86662123,"identity":"3010487b-865a-4234-bcdb-360844cbf236","added_by":"auto","created_at":"2025-07-14 10:41:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":296595,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of patient selection.\u003c/p\u003e\n\u003cp\u003eNSCLC: non-small cell lung cancer\u003c/p\u003e\n\u003cp\u003eJan: January\u003c/p\u003e\n\u003cp\u003eDec: December\u003c/p\u003e\n\u003cp\u003eVPI: visceral pleural invasion\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6631641/v1/da14ee2dfda9f826191e9669.png"},{"id":86662124,"identity":"2b310903-375d-4d88-998f-3b07faf34ea9","added_by":"auto","created_at":"2025-07-14 10:41:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":273209,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meyer curve for patients who underwent different surgical procedures (Segmentectomy vs Lobectomy). (A) Overall survival (B) Disease specific survival and (C) Recurrence free survival.\u003c/p\u003e\n\u003cp\u003eLob: Lobectomy\u003c/p\u003e\n\u003cp\u003eSeg: Segmentectomy\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6631641/v1/4230c2350cb73343eb403b54.png"},{"id":86662125,"identity":"2f7c2564-cfb8-498e-bf55-a98ff0cd5222","added_by":"auto","created_at":"2025-07-14 10:41:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":257107,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meyer curve for patients who underwent different surgical procedures (Segmentectomy vs Lobectomy): propensity score-matched analysis (1:1). (A) Overall survival (B) Disease specific survival and (C) Recurrence free survival\u003c/p\u003e\n\u003cp\u003eLob: Lobectomy\u003c/p\u003e\n\u003cp\u003eSeg: Segmentectomy\u003c/p\u003e","description":"","filename":"OnlineFigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-6631641/v1/7bb0e81b042d6aafdae12f99.png"},{"id":86662128,"identity":"ab13b6c2-b16d-49ec-903f-d8785a3a970c","added_by":"auto","created_at":"2025-07-14 10:41:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":208739,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meyer curve for patients with tumor ≦2cm who underwent different surgical procedures (Segmentectomy vs Lobectomy): propensity score-matched analysis (1:1). (Cohort2)\u003c/p\u003e\n\u003cp\u003e(A) Overall survival (B) Disease specific survival and (C) Recurrence free survival\u003c/p\u003e\n\u003cp\u003eLob: Lobectomy\u003c/p\u003e\n\u003cp\u003eSeg: Segmentectomy\u003c/p\u003e\n\u003cp\u003ePMA: propensity matched analysis\u003c/p\u003e","description":"","filename":"OnlineFigure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6631641/v1/794ee87446fd09a997a1931a.png"},{"id":86663306,"identity":"3a684756-c884-4320-9fd5-1934d18e2165","added_by":"auto","created_at":"2025-07-14 10:49:02","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":216973,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meyer curve for patients with tumor \u0026gt;2cm who underwent different surgical procedures\u003c/p\u003e\n\u003cp\u003e(Segmentectomy vs Lobectomy): propensity score-matched analysis (1:3). (Cohort3)\u003c/p\u003e\n\u003cp\u003e(A) Overall survival (B) Disease specific survival and (C) Recurrence free survival\u003c/p\u003e\n\u003cp\u003eLob: Lobectomy\u003c/p\u003e\n\u003cp\u003eSeg: Segmentectomy\u003c/p\u003e\n\u003cp\u003ePMA: propensity matched analysis\u003c/p\u003e","description":"","filename":"OnlineFigure5.png","url":"https://assets-eu.researchsquare.com/files/rs-6631641/v1/3ac9874a8358188a85602814.png"},{"id":99172850,"identity":"b3290e6f-11fc-4853-abbc-0553f14a54df","added_by":"auto","created_at":"2025-12-29 16:11:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2717997,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6631641/v1/a8a4fc99-6461-4f03-9175-c5cc86e96285.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of segmentectomy and lobectomy for non-small cell lung cancer with visceral pleural invasion","fulltext":[{"header":"Background","content":"\u003cp\u003eSurgical resection is currently the mainstay of curative treatment for early-stage non-small cell lung cancer (NSCLC). Visceral pleural invasion (VPI) has a significant impact on staging and prognosis and is an important factor in determining surgical strategy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Previous studies demonstrated that NSCLC patients with VPI have more progressive tumors and are at an increased risk of mediastinal lymph node metastasis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and recurrence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, lobectomy, which allows more adequate resection, has been considered the standard technique [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, segmentectomy is increasingly indicated for the preservation of pulmonary function, particularly in elderly patients and those with comorbidities. It was recently suggested that segmentectomy provides a comparable prognosis to that associated with lobectomy in patients with small tumors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and its appropriateness is also being examined in patients with pleural involvement.\u003c/p\u003e\u003cp\u003eHowever, there is limited evidence on the prognostic comparison of segmentectomy versus lobectomy in NSCLC with VPI. Moreover, there is no clear consensus on the impact of tumor size on surgical selection and prognosis. The impact of resection technique on the recurrence pattern and cause of death has also not been fully investigated.\u003c/p\u003e\u003cp\u003eIn the present study, we retrospectively analyzed the effect of tumor size and surgical technique on prognosis, recurrence pattern, and cause of death in patients with NSCLC with pleural invasion. In particular, we aimed to gain insight into future treatment strategies by comparing the outcomes of segmentectomy and lobectomy in two groups of patients with tumor diameters measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm and \u0026gt;\u0026thinsp;2 cm.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient population\u003c/h2\u003e\u003cp\u003eThe internal review board (ERB-111369) at our hospital approved this study. Overall, 922 patients with NSCLC who underwent curative lung resection from 2012 to 2022 were included in the present investigation. Of those, 218 patients with VPI were evaluated (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients who underwent segmentectomy (n\u0026thinsp;=\u0026thinsp;42) were classified into cohort 1; those with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm (n\u0026thinsp;=\u0026thinsp;22) and \u0026gt;\u0026thinsp;2 cm (n\u0026thinsp;=\u0026thinsp;20) were classified into cohort 2 and cohort 3, respectively. These patients as well as 150 patients who underwent lobectomy were analyzed; subsequently, cohort 1 (n\u0026thinsp;=\u0026thinsp;38), cohort 2 (n\u0026thinsp;=\u0026thinsp;22), and cohort 3 (n\u0026thinsp;=\u0026thinsp;20) were background-matched by the grade of VPI, tumor size, age, sex, histology, and pathological nodal stage. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the background of the 42 and 150 patients who underwent segmentectomy and lobectomy, respectively. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the patient background after propensity score matching (PSM).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of patients undergoing segmentectomy or lobectomy.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSegment resection\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLobar resection\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;150)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;72 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;72 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3.1cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3.1cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon adenoca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdenoca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIIA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological Nodal Stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePleural invasion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epl1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epl2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epl3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient characteristics of propensity score matched cohort.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSublobar resection\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLobar resection\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;72 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;72 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3.1cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3.1cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon adenoca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdenoca\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePathological stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIIA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological Nodal Stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePleural invasion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epl1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epl2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epl3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePatient outcomes and follow-up\u003c/h3\u003e\n\u003cp\u003eStandard follow-up for patients included chest computed tomography scans, physical examinations, and blood tests that were conducted every 3\u0026ndash;6 months for the first 3 years following the procedure, and every 6\u0026ndash;12 months thereafter. 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging were also performed when necessary. Median duration of follow-up in our study was 54 months (mean: 49.2; range: 24\u0026ndash;134 months). The primary outcome was recurrence-free survival (RFS), defined as the period of time from initial surgical resection to the first evidence of recurrence. Lesion imaging and physical examinations were used to diagnose tumor recurrence. Histological confirmation of the diagnosis was also performed when it was clinically feasible.\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eThe associations between clinical outcomes and imaging and clinical metrics were evaluated using multivariate and univariate Cox proportional hazards regression models. The 95% confidence intervals were calculated, and the percentages were two-sided. For continuous variables, presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, the student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test was employed to assess significant differences. For categorical variables, the chi-squared test was utilized to assess statistical significance. The SAS software package (SAS Institute, Inc., Cary, NC, USA) was used for statistical analyses. The p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicate statistically significant differences.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the overall survival (OS), disease-specific survival, and RFS associated with each procedure in cohort 1. No statistically significant difference was found between the two groups (p\u0026thinsp;=\u0026thinsp;0.24, 0.34, and 0.88, respectively). Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the OS, disease-specific survival, and RFS linked to each procedure after PSM in cohort 1. No statistically significant difference was found between the two groups (p\u0026thinsp;=\u0026thinsp;0.47, 0.46, and 0.69, respectively).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the OS and RFS following each procedure after PSM in cohort 2; similarly, no difference was found between the two groups (p\u0026thinsp;=\u0026thinsp;0.17 and 0.94, respectively). Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the OS and RFS after each surgical procedure in the group of patients with tumors measuring\u0026thinsp;\u0026gt;\u0026thinsp;2 cm (cohort 3). Results indicated that the RFS was better in the lobectomy group compared with the segmentectomy group, although the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.08).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the causes of death according to each procedure after PSM. There was no difference between the groups in the rate of deaths related to lung cancer; however, there was a trend toward more deaths from other diseases in the lobectomy group versus the segmentectomy group. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the recurrence patterns after each procedure in the patients with tumors measuring\u0026thinsp;\u0026gt;\u0026thinsp;2 cm. The segmentectomy group had a significantly higher rate of pleural dissemination recurrence than the lobectomy group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of causes of death during follow-up.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSegmentectomy \u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLobectomy \u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (73.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (63.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCause of death\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003elung cancer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (23.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eother cancer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003epneumonia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRenal failure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003epulmonary embolism\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ehypoglycemic attack\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIP: interstitial pneumonia\u003c/p\u003e\n\u003cp\u003eAMI: acute myocardial infarction\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRecurrence pattern by surgical procedure after propensity matched analysis.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSegmentectomy \u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLobectomy \u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (55.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43 (71.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMode of recurrence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLoco-regional\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDissemination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, we investigated the relationship between tumor size and surgical technique and its impact on prognosis in the surgical treatment of NSCLC with VPI. The results showed that in patients with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm, segmentectomy was as good as or better than lobectomy, while lobectomy was linked to a better prognosis in those with tumors measuring\u0026thinsp;\u0026gt;\u0026thinsp;2 cm. These findings may be useful in reconsidering the indications for reduction surgery in patients with pleural invasion.\u003c/p\u003e\u003cp\u003ePleural involvement is an important factor in the staging of early-stage NSCLC. The International Association for the Study of Lung Cancer has recognized the importance of VPI for up-staging in the 7th edition of the NSCLC staging system and incorporated it into the tumor-node-metastasis (TNM) staging system [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Subsequent studies have revealed that VPI is linked to poor prognosis in patients with early-stage NSCLC, and the PL classification has been reconsidered for inclusion in the 8th edition of the TNM staging system [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Several investigations, including the Japan Clinical Oncology Group 0802 study, have demonstrated the safety and effectiveness of segmental resection with hilar and mediastinal lymph node dissection in patients with early-stage NSCLC and tumors measuring\u0026thinsp;\u0026le;\u0026thinsp;2 cm [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding the prognosis of early-stage lung cancer with VPI, the 5-year survival rates of patients with stage IB NSCLC who underwent surgical reduction or lobectomy were comparable [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nonetheless, Yu et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] showed that patients with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm and VPI had an improved long-term prognosis following resection. Furthermore, it has been reported that partial resection is sufficient in older patients (aged\u0026thinsp;\u0026gt;\u0026thinsp;80 years) with clinical stage I lung cancer even if the tumor is VPI-positive [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Several recent studies have reported reduced resection with VPI as the primary focus and lobectomy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]; however, the appropriate surgical treatment remains controversial.\u003c/p\u003e\u003cp\u003eIn patients with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm, the local spread of the tumor is relatively low, and even with pleural invasion, the tumor is likely to be confined to the area; thus, zonal resection may provide adequate local control. In addition, zonal resection may be a useful option, especially for elderly patients or those with impaired respiratory function, because it is superior in preserving lung function, improves postoperative quality of life, and reduces the risk of other diseases. Nevertheless, if the tumor measures\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, it is likely to have more advanced pleural involvement, and there is a risk that a regional resection may be inadequate in terms of microinvasion and spread to adjacent areas. Lobectomy allows for more extensive lymph node dissection and local control, which may improve prognosis.\u003c/p\u003e\u003cp\u003eIn the present study, the frequency of pleural seeding recurrence was higher after segmentectomy compared to lobectomy, presumably due to the influence of resection margins and peritumoral pathology. These findings also suggest that lobectomy is superior in terms of tumor control in patients with tumors measuring\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, whereas lobectomy is not necessary in those with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm simply because they are VPI-positive.\u003c/p\u003e\u003cp\u003eThe higher incidence of death from other causes in the lobectomy group may be due to the more invasive nature of the procedure, decreased pulmonary function after the procedure, and systemic risks derived from patient background. Therefore, it is important to construct an individualized treatment strategy that takes into account tumor factors and the general condition of the patient, as well as the presence or absence of complications when selecting a surgical approach; furthermore, a detailed analysis of risk factors is necessary. According to the evidence, in NSCLC patients with pleural invasion, regional resection may be a safe and effective option for those with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm, while lobectomy may be more appropriate for those with tumors measuring\u0026thinsp;\u0026gt;\u0026thinsp;2 cm.\u003c/p\u003e\u003cp\u003eMoreover, the degree of pleural involvement (PL1, PL2, and PL3) has been reported to affect prognosis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. PL1, PL2, and PL3 refer to involvement beyond the elastic layer, pleural surface, and all layers of the pleura, respectively, and prognosis tends to worsen as the degree of involvement progresses. In the present study, PL positivity was examined collectively, studies in the future should include subgroup analysis by the degree of PL.\u003c/p\u003e\u003cp\u003eThis study had several limitations. Firstly, this is a retrospective, single-center investigation with a limited number of cases. Secondly, regarding the type of resection, limited resection was performed for high-risk patients, whereas lobectomy was more desirable.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn patients with VPI-positive lung cancer, segmentectomy may offer a better prognosis than lobectomy for those with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm. Nevertheless, lobectomy should be considered first for patients with tumors measuring\u0026thinsp;\u0026gt;\u0026thinsp;2 cm. A balance between local control of the tumor and preservation of pulmonary function should be considered when selecting a surgical approach. Prospective studies are warranted to establish optimal treatment strategies for this disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003enon-small cell lung cancer (NSCLC)\u003c/p\u003e\n\u003cp\u003evisceral pleural invasion (VPI)\u003c/p\u003e\n\u003cp\u003epropensity score matching (PMA)\u003c/p\u003e\n\u003cp\u003ecomputed tomography (CT)\u003c/p\u003e\n\u003cp\u003efluorodeoxyglucose positron emission tomography (FDG-PET)\u003c/p\u003e\n\u003cp\u003erecurrence-free survival (RFS)\u003c/p\u003e\n\u003cp\u003eoverall survival (OS)\u003c/p\u003e\n\u003cp\u003edisease specific survival (DSS)\u003c/p\u003e\n\u003cp\u003eInternational Association for the Study of Lung Cancer (IASLC)\u003c/p\u003e\n\u003cp\u003eJapan clinical oncology group (JCOG)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by our hospital\u0026rsquo;s internal review board (ERB-111369).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. \u0026nbsp;A copy of the written consent is available for review by the Editor- in- chief of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of supporting data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTS, NF, YB, MY, RM, HO analyzed and interpreted the patient data. MT performed the literature review and was a major contributor in writing the manuscript. MT and HO performed the final editing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFibla JJ, Cassivi SD, Brunelli A, Decker PA, Allen MS, Darling GE, et al. Re-evaluation of the prognostic value of visceral pleura invasion in Stage IB non-small cell lung cancer using the prospective multicenter ACOSOG Z0030 trial data set. Lung Cancer. Dec; 2012;78(3):259\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.lungcan.2012.09.010\u003c/span\u003e\u003cspan address=\"10.1016/j.lungcan.2012.09.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Level of pleural invasion effects on prognosis in lung cancer. Tumori. 2019;105:155\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0300891618792463\u003c/span\u003e\u003cspan address=\"10.1177/0300891618792463\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2018 Aug 30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzden S, Gokdemir I, Kiyik M. The relationship between the degree of visceral pleural invasion and survival in non-small cell lung cancer. 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Mar; 2020;12(3):592\u0026ndash;604. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/jtd.2019.12.121\u003c/span\u003e\u003cspan address=\"10.21037/jtd.2019.12.121\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi S, Ge Y, Ma R, Wang J, Ma T, Sun T, et al. Comparison of wedge resection and anatomical lung resection in elderly patients with early-stage non-small cell lung cancer with visceral pleural invasion: a population-based study. Thorac Cancer. Feb; 2025;16(3):e15532. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/1759-7714.15532\u003c/span\u003e\u003cspan address=\"10.1111/1759-7714.15532\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhitehorn GL, Rshaidat H, Madeka I, Martin J, Mack SJ, Meredith L, et al. Lobectomy is not associated with improved survival as compared to segmentectomy in early-stage lung cancer patients with visceral pleural invasion. Clin Lung Cancer. 2025;26(2):e99\u0026ndash;107. e10. Epub 2024 Nov 18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMathey-Andrews C, Abruzzo AR, Venkateswaran S, Potter AL, Senthil P, Beqari J, et al. Segmentectomy vs lobectomy for early non-small cell lung cancer with visceral pleural invasion. Ann Thorac Surg. May; 2024;117(5):1007\u0026ndash;14. Epub 2023 Jul 5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"non-small cell lung cancer (NSCLC), visceral pleural invasion (VPI), segmentectomy, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-6631641/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6631641/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eVisceral pleural invasion (VPI) is known to have a significant impact on staging and prognosis in NSCLC and is an important factor in determining surgical strategy. The aim of this study was to compare the outcomes of surgical procedure (segmentectomy vs lobectomy) with VPI positive patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA retrospective study was conducted on 218 VPI positive NSCLC patients were studied, with the segmentetomy group (n\u0026thinsp;=\u0026thinsp;42) designated as cohort.1, cases with tumor diameter less than 2 cm (n\u0026thinsp;=\u0026thinsp;22) designated as cohort.2, and cases with greater than 2 cm (n\u0026thinsp;=\u0026thinsp;20) designated as cohort.3. Each group and 150 cases of lung lobectomy were analyzed. Cause of death and recurrence mode were investigated.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere was no difference in OS, DSS and RFS between segmentectomy and lobectomy after propensity matched analysis. There was no difference in OS and RFS in the group of cases\u0026thinsp;\u0026lt;\u0026thinsp;2 cm. In patients with \u0026gt;\u0026thinsp;2 cm, there was a trend toward a better prognosis for lobectomy compared to segmentectomy in terms of RFS (p\u0026thinsp;=\u0026thinsp;0.08). There was no difference in lung cancer deaths, but there was a trend toward more deaths from multiple disease in the lobectomy group (p\u0026thinsp;=\u0026thinsp;0.07), and pleural dissemination recurrence was significantly more common in the segmentectomy group than in the lobectomy group in the \u0026gt;\u0026thinsp;2 cm group (p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn patients with VPI positive lung cancer, segmentectomy may offer a better prognosis for those with tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;2 cm. Nevertheless, lobectomy should be considered first for patients with tumors measuring\u0026thinsp;\u0026gt;\u0026thinsp;2 cm.\u003c/p\u003e","manuscriptTitle":"Comparison of segmentectomy and lobectomy for non-small cell lung cancer with visceral pleural invasion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 10:40:57","doi":"10.21203/rs.3.rs-6631641/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-16T20:55:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-17T07:30:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-15T15:54:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-10T15:02:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125253545500620689580952226733661512172","date":"2025-07-10T14:16:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299613525506429914623065604232230051753","date":"2025-07-10T07:19:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136338594783702743504607557941727684792","date":"2025-07-10T02:19:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-09T23:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112535925878800316775520379777748188983","date":"2025-07-09T21:56:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183966491604803408347144772062389778154","date":"2025-07-09T13:12:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20525624091030291407145885211552275310","date":"2025-07-09T10:58:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-09T10:27:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-12T13:47:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-12T13:43:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-05-09T23:33:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e29dea06-67ca-442e-8a0f-212827ee32be","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:09:27+00:00","versionOfRecord":{"articleIdentity":"rs-6631641","link":"https://doi.org/10.1186/s13019-025-03715-0","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2025-12-24 15:58:34","publishedOnDateReadable":"December 24th, 2025"},"versionCreatedAt":"2025-07-14 10:40:57","video":"","vorDoi":"10.1186/s13019-025-03715-0","vorDoiUrl":"https://doi.org/10.1186/s13019-025-03715-0","workflowStages":[]},"version":"v1","identity":"rs-6631641","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6631641","identity":"rs-6631641","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}