Tumour Spread Through Air Spaces Is a Determiner for Treatment of Clinical Stage I Non-Small Cell Lung Cancer: Thoracoscopic Segmentectomy vs Lobectomy

This study investigates the impact of tumor spread through air spaces (STAS) on surgical outcomes for early-stage non-small cell lung cancer (NSCLC). In a retrospective analysis of 785 patients, 19.2 percent were found to have STAS-positive NSCLC. The study revealed no significant difference in overall survival (OS) or recurrence-free survival (RFS) between segmentectomy and lobectomy for STAS-negative patients. However, for STAS-positive patients, segmentectomy was associated with significantly worse outcomes, with a three-year OS of 58.4 percent compared to 89.0 percent for lobectomy (p < 0.001), and a three-year RFS of 69.8 percent vs. 82.7 percent (p < 0.001).   This study is crucial for the cardiothoracic surgery community as it reinforces the need for careful surgical planning in STAS-positive NSCLC cases. It highlights the importance of considering STAS status when choosing between segmentectomy and lobectomy to optimize oncological outcomes​.