Sublobar resection: a movement from the Lung Cancer Study Group

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonology

Background:

• The 1995 Lung Cancer Study Group recommended lobectomy for stage I non-small cell lung cancer (NSCLC).
• Advancements in imaging (e.g., multislice CT) detect smaller, earlier-stage NSCLC.
• Minimally invasive surgery (VATS) offers reduced morbidity and equivalent oncologic outcomes to open surgery.

Purpose of the Study:

• To review literature on sublobar resection for early-stage NSCLC.
• To assess the oncologic effectiveness and safety of sublobar resection versus lobectomy.
• To inform future research and clinical practice regarding surgical options for NSCLC.

Main Methods:

• Literature review of studies published over the past 15 years.
• Analysis of single-institution trials comparing sublobar resection to lobectomy.
• Consideration of ongoing prospective, randomized multi-institutional trials (e.g., CALGB 140503).

Main Results:

• Single-institution trials suggest comparable survival and recurrence rates for well-selected sublobar resections.
• Sublobar resection may be particularly beneficial for high-risk patients with small stage IA NSCLC.
• Ongoing trials aim to definitively establish non-inferiority of sublobar resection.

Conclusions:

• The mandatory use of lobectomy for small stage IA NSCLC is being challenged.
• Sublobar resection is a viable alternative for select patients with early-stage NSCLC.
• Further evidence from large-scale trials is crucial for widespread adoption.