Survival after wedge resection, segmentectomy and lobectomy for clinical stage IA non-small cell lung cancer: a systematic review and network meta-analysis.

Background: Surgical resection remains the cornerstone of early-stage treatment for non-small cell lung cancer (NSCLC). However, the survival benefits of different surgical methods in clinical stage IA patients remain controversial. This systematic review aims to compare the efficacy of surgical methods-lobectomy, segmentectomy, and wedge resection-on survival outcomes in clinical stage IA NSCLC patients. Methods: A systematic search was performed in PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases between January 2000 and November 30, 2024. Studies meeting the inclusion and exclusion criteria were identified, and hazard ratio (HR) for overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) were extracted from each study for pairwise and Bayesian network meta-analyses. This study protocol was registered on PROSPERO (CRD42024618659). Results: A total of 58 retrospective studies and 3 randomized controlled trials (RCTs) were included. For patients with overall stage IA, network meta-analyses showed that both lobectomy and segmentectomy had significant advantages in OS, DFS, and RFS compared to wedge resection {HROS 0.67 [95% confidence interval (CI): 0.59-0.75], 0.75 (95% CI: 0.65-0.84); HRDFS 0.69 (95% CI: 0.54-0.89), 0.71 (95% CI: 0.55-0.92); HRRFS 0.57 (95% CI: 0.42-0.78), 0.53 (95% CI: 0.39-0.72)}. No significant differences were observed between lobectomy and segmentectomy. Based on ranking probabilities, lobectomy ranked first. In subgroup analyses, results for overall T1a/b patients were consistent with those of stage IA. When 0.5< consolidation-to-tumor ratio (CTR) <1, lobectomy and segmentectomy showed significant advantages in OS and RFS compared to wedge resection [HROS 0.57 (95% CI: 0.38-0.94), 0.52 (95% CI: 0.34-0.84); HRRFS 0.53 (95% CI: 0.32-0.83), 0.51 (95% CI: 0.31-0.84)], while no significant differences were observed otherwise. Segmentectomy ranked first in this group. When CTR =1, no significant differences were found, with lobectomy ranking first. For overall T1c patients, lobectomy demonstrated significant advantages in OS compared to segmentectomy and wedge resection [HR 0.73 (95% CI: 0.60-0.91); HR 0.60 (95% CI: 0.44-0.77)], while no significant differences were observed otherwise. Lobectomy ranked first in this group. For patients with 0.5< CTR <1, no significant differences were found, with lobectomy ranked first. Conclusions: Lobectomy and segmentectomy provide better OS benefits compared to wedge resection in stage IA NSCLC patients, with no significant differences between lobectomy and segmentectomy. However, the optimal surgical approach should still be determined based on tumor size and CTR.