Meta-analysis of 10,620 Patients: Inferior Survival after Sublobar Lung Resection in NSCLC

Objectives: Lobectomy is the gold standard in the surgical treatment of non-small cell lung cancer (NSCLC). Nevertheless tissue-sparing procedures are being performed daily. The impact of a sublobar resection on survival remains unclear. This meta-analysis compares the 5-year survival following lobectomy and sublobar resection.

Methods: A systematic literature research was executed on 15th August 2018 in Medline and Cochrane databases. We included prospective randomized and retrospective articles that were published since 1994. Two groups were formed for a statistical comparison (group A: lobectomy; group B: sublobar resection (wedge resection or segmentectomy). Established statistical methods such as I ²-test and Q-statistics; Mantel–Haenszel’s test or DerSimonian–Laird’s test, and Egger regression were performed. By executing a subgroup analysis of “matched-pair” cases, we excluded a possible influence of comorbidities on survival. Additionally, the subgroup of patients in stage IA was analyzed separately.

Results: Out of 1,646 studies, we included 39 articles into this meta-analysis. A publication bias was not observed (Egger regression: p = 0.177). The meta-analysis is based on a total of 10,620 patients (group A: n = 7,766; group B: n = 2,854). All baseline characteristics such as age, gender distribution, smoking history, and COPD are similar in both groups (p-value >0.05). The mean age of the patients is 68.3 ± 8.1 years; 59.6 ± 3.8% of the patients are male. The DerSimonian–Laird’s test was executed (I ²-test: 56.8%) and revealed a significant longer 5-year survival of patients in all stages after lobectomy compared to patients after sublobar resection (odds ratio: 1.52; 95% confidence interval: 1.27–1.81; p-value < 0.001). Furthermore, the subgroup analysis of “matched-pair” cases showed a significantly improved survival after lobectomy (odds ratio: 1.46; 95% confidence interval: 1.19–1.79; p-value < 0.001). Finally, there was no significant difference in 5-year survival between lobectomy and sublobar resection in stage IA NSCLC (odds ratio: 1.53; 95% confidence interval: 0.98–2.39; p-value = 0.061).

Conclusion: This meta-analysis reveals a 5-year survival benefit after lobectomy in all stages. A tissue-sparing procedure in treatment of NSCLC is associated with shorter long-term survival. Comorbidities do not have any impact on these findings. Small tumors may be resected by a sublobar resection.