The lesser the better? A systematic review and meta-analysis of resection strategy in lung neuroendocrine tumors.

INTRODUCTION

Lung neuroendocrine tumors (LNETs) are rare, with surgical resection as the mainstay of treatment, although the optimal extent remains uncertain. Herein, we present the first meta-analysis to assess the effect of resection extent (lobar vs. sub-lobar) on overall survival.

METHODS

We conducted a systematic review of the literature to identify studies comparing overall survival following lobectomy versus sub-lobar resection in LNETs. An inverse-variance meta-analysis was performed, and a Cox regression model was applied to reconstructed time-to-event data estimated from published Kaplan-Meier curves to generate pooled survival estimates.

RESULTS

Six studies encompassing 3,700 patients (lobectomy, n = 2,409; sub-lobar resection, n = 1,291) were included in the final analysis. The pooled 5-year overall survival for the entire cohort was 78.8% (95% CI, 76.6-81.1). No statistically significant difference in overall survival was observed between lobectomy and sub-lobar resection (HR = 1.21; 95% CI, 0.80-1.83; I2 = 0%). Segmentectomy and lobectomy demonstrated comparable survival (p = 0.38), whereas wedge resection was associated with higher mortality (HR = 2.02; 95% CI, 1.64-2.49; I2 = 0%). Sampling of >10 lymph nodes was more frequent in lobectomy than sub-lobar resection (29.1% [95% CI, 0.8-95.3] vs 7.4% [95% CI, 0.01-98], respectively), likely contributing to the higher rate of nodal pathologic upstaging observed in the lobectomy group (6.2% [95% CI, 0.2-64.9] vs 2.2% [95% CI, 0-99]).

CONCLUSION

In this first meta-analysis of surgical resection for LNETs, sub-lobar resection and lobectomy showed no clear difference in overall survival. Adequate lymph node assessment remains essential, irrespective of the surgical approach.