Outcomes of Segmentectomy With or Without Preoperative Biopsy in Non-Small Cell Lung Cancer (NSCLC).

Background: There is a discussion amongst oncologic societies regarding the necessity of preoperative biopsy prior to resection in lung cancer. We aim to examine outcomes of segmentectomy with or without preoperative biopsy in non-small cell lung cancer (NSCLC) patients.

Methods: A retrospective cohort study was conducted utilizing the National Cancer Database. Adult patients diagnosed with clinical stage I (N0 M0, tumor size ≤ 2 cm) NSCLC between 2010 and 2019 who underwent segmentectomy were included. Patients with carcinoid tumors or who received neoadjuvant systemic or radiation therapy were excluded. Demographic and clinical variables were analyzed. Propensity score matching (PSM) was performed to adjust for confounders between patients who underwent segmentectomy with versus without preoperative biopsy. Short term outcomes (readmission, 30-day and 90-day survival) and long-term overall survival (OS) were compared between groups.

Results: In total, 6891 patients met inclusion criteria, of which 2287 (33.2%) underwent preoperative biopsy and 4604 (66.8%) did not. There was no significant difference in 30-day readmission (P = .13), 30-day survival (P = .26), and 90-day survival (P = .31). Patients who did not receive preoperative biopsy was associated with a higher 5-year OS (P = .02); however, post-PSM, there was no significant difference between the 2 groups (P = .20).

Conclusions: After PSM, no significant difference was found in margin positivity, nodal upstaging, 30-day readmission, 30- and 90-day survival, and 5-year OS between cohorts. This demonstrates that segmentectomy without preoperative biopsy remains a safe option for those with early stage, ≤ 2 cm NSCLC.