AIM: This study aimed to explore the clinical application of surgical methods based on different lung segments and pathological subtypes in the treatment of T1b lung adenocarcinoma.

METHODS: A total of 207 patients with T1b lung adenocarcinoma admitted to the hospital between December 2019 and December 2022 were included in a retrospective analysis. According to the different surgical treatment strategies, all patients were divided into two groups: control group (n = 117) and experimental group (n = 90). The surgical methods for the control group were based on consolidation-to-tumour ratio (CTR), and the experimental group were according to lung segments and pathological subtypes. All patients were followed up for three years. Kaplan–Meier curve and Cox proportional hazard analysis were adopted to analyze the 3-year overall survival (OS) and recurrence-free survival (RFS) of two groups.

RESULTS: Compared with the control group, the proportion of lobectomy, lymph node management strategy, total nodes retrieved, number of stations, blood loss and operation time in the experimental group were decreased (p < 0.05), and the forced expiratory volume in 1 second (FEV₁) after surgery was increased. During the 3-year follow-up, there were 15 cases of recurrence (12.82%) and 6 cases of death (5.13%) in the control group; there were 9 cases of recurrence (10.00%) and 4 cases of death (4.44%) in the experimental group. There was no significant difference in recurrence or mortality between the two groups (p > 0.05). Kaplan-Meier curves showed no significant differences in 3-year disease-free survival (DFS) rate or 3-year overall survival (OS) rate between the two groups (p = 0.456, 0.623). Cox univariate analysis showed that the risk factors affected RFS were micropapillary pathological subtype (hazard ratio (HR) = 4.125, 95% confidence interval (CI) = 1.241–13.709, p = 0.021) and middle and lower lobes (HR = 2.633, 95% CI = 1.092–6.350, p = 0.031).

CONCLUSIONS: For T1b lung adenocarcinoma, incorporating tumor location and pathological subtype into surgical decisions may be beneficial to patient outcomes. This study may provide a reference for personalized treatment of small-sized lung cancer.