Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Lung cancer is the leading cause of cancer-related death (26.5% of all) and has the second highest annual incidence in both males and females (13.3% for each), in the United States (1). More than half of lung cancer patients (57%) have distant metastasis at diagnosis, and overall 5-year relative survival rate is as low as 18% (1). Lung cancer can be divided into small cell lung cancer (SCLC, less than 20%) and non-small cell lung cancer (NSCLC, more than 80%), with entirely different treatment strategies and prognosis (2). Treatment strategies mainly include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy (2). Therein, approximately 69% of NSCLC patients with stages I and II are treated by surgery, compared to only 9% of patients with stages III and IV (2). Surgery is considered the best treatment option for early stage lung cancer, and anatomical lobectomy with N1 and at least three N2 stations sampling or dissection has become the standard surgery for early NSCLC patients (3). Minimally invasive video-assisted thoracoscopic lobectomy is also preferred for stage I NSCLC patients (4)