Comparison of Segmentectomy Versus Lobectomy for Non-small Cell Lung Cancer ≤ 2 cm in the Middle Third of the Lung Field

Nowadays, the role of segment resection in the treatment of non-small cell lung cancer ≤ 2 cm in the outer third of the lung field has been evaluated in multiple studies. Recently, professor Hisao Asamura released the long-term results of the JCOG0802 project in AATS 2021. Segmentectomy had a higher 5-year overall survival (94.3% vs. 91.1%) than lobectomy (P < 0.001) for non-small cell lung cancer ≤ 2 cm (CTR > 0.5) in the outer third of the lung field. However, a substantial portion of lung nodules was not located in the outer third, but the middle third of the lung field. Whether segmentectomy has non-inferiority long-term oncological effects compared to lobectomy for early-stage non-small cell lung cancer ≤ 2 cm in the middle third of lung field remains unclear. This randomized controlled trial study aims to investigate whether segmentectomy has non-inferiority long-term oncological effects compared to lobectomy for early-stage non-small cell lung cancer ≤ 2 cm in the middle third of the lung field.

Inclusion criteria

• Patient aged 18-75 years old;
• 6 mm ≤ tumor size ≤ 20 mm;
• 0.25 < CTR < 1;
• Center of tumor located in the middle third of the lung field;
• ECOG score of 0,1 or 2;
• Lung function (FEV1 ≥ 1 L and ≥ 70%);
• Both lung segmentectomy and lobectomy could achieve R0 resection;
• No serious cardiopulmonary complications, and could withstand both lung segmentectomy and lobectomy;
• No hilus pulmonis and mediastinal lymph node metastasis and no distant metastasis;
• Single tumor nodule or the concomitant nodule < microinvasive tumor;
• Written informed consent.

Exclusion criteria

• The tumor nodule is located in right middle lobe;
• A history of other malignancies in the last 5 years (exclusion of early-staged thyroid cancer);
• Have received preoperative anti-tumor therapy, including prior chemotherapy, radiation therapy, target therapy and so on;
• A serious mental illness;
• Pregnant and lactating women;
• Congestive heart failure, myocardial infarction, severe stenosis of coronary artery within recent 6 months;
• With the history of cerebral infarction or cerebral hemorrhage within 6 months;
• With the history of sustained systemic corticosteroid therapy within 1 month;
• The predicted surgical margin is less than 2 cm or the maximum diameter of the tumor at the 3D-CTBA
• Other unsuitable situations;