Lobectomy offers higher incidence of up-staging in patients with T1a-c non-small cell lung carcinomas: Is completion lobectomy necessary?

Introduction
Completion lobectomy is defined as the excision of the remaining lobe following a previous sublobar resection. While it is considered a salvage option in selected cases, its impact on nodal staging and overall survival remains unclear in patients with early-stage non-small cell lung cancer (NSCLC).

Aim
This study aimed to evaluate the effect of completion lobectomy on nodal upstaging and overall survival in patients with T1a-c NSCLC.

Material and methods
A retrospective analysis was conducted on 477 patients with pathologically confirmed NSCLC and tumor size ≤ 3 cm, who underwent sublobar resection (n = 45), lobectomy (n = 270), or completion lobectomy (n = 117) between 2001 and 2023. Patients were stratified into subgroups based on tumor size: 0–2 cm (T1a,b) and 2–3 cm (T1c). Clinical, surgical, and pathological parameters, as well as survival data, were compared among groups.

Results
The lobectomy group demonstrated significantly higher rates of N1 nodal involvement compared to the sublobar group (p < 0.001). The VATS approach and N0 status were more common in the sublobar resection group (p < 0.001). Perineural, lymphatic, and vascular invasion were significantly less frequent in the sublobar group (p = 0.001, p = 0.032, and p = 0.004, respectively). No significant difference in overall survival was observed among surgical groups (p = 0.164); however, lobectomy yielded better survival in T1a,b tumors (p = 0.037). Nodal status, perineural invasion, and stage were independent predictors of survival (p = 0.002 and p = 0.02).

Conclusions
Lobectomy results in higher pathological upstaging in cT1N0M0 NSCLC. Completion lobectomy is feasible and safe when nodal upstaging occurs following segmentectomy, though it may not confer a survival advantage in cT1aN0 cases.