[Sublobar curative resection for non-small-cell lung cancer]

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• The Lung Cancer Study Group trial (1995) established lobectomy as superior to sublobar resection for lung cancers <3cm.
• Lobectomy with lymph node resection is the standard recommendation.
• Recent studies suggest comparable outcomes for segmentectomy (<2cm) and wedge resection (<1cm) tumors.

Purpose of the Study:

• To evaluate the efficacy of sublobar resection versus lobectomy for early-stage lung cancer.
• To determine optimal surgical strategies for small lung adenocarcinomas, including ground glass opacities.
• To assess the role of surgical margins in preventing local recurrence.

Main Methods:

• Review of existing literature and ongoing clinical trials comparing lobectomy and sublobar resection.
• Analysis of outcomes for different tumor sizes and resection types (lobectomy, segmentectomy, wedge resection).
• Focus on macroscopic margin adherence and recurrence rates.

Main Results:

• Lobectomy demonstrated superiority for lung cancers <3cm in the 1995 trial.
• Some publications indicate similar results for segmentectomy (<2cm) and wedge resection (<1cm).
• Maintaining a macroscopic margin >2cm appears crucial for avoiding local recurrence.

Conclusions:

• Sublobar resection may be a viable option for select small lung cancers (<2cm), particularly pure or minimally invasive adenocarcinomas.
• Careful margin assessment is critical for successful sublobar resection.
• Ongoing trials are further investigating the optimal surgical approach for early-stage lung cancer.