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Wedge Resection vs Lobectomy for Clinical Stage IA Non-Small Cell Lung Cancer With Occult Lymph Node Disease
Peter J Kneuertz1, Mahmoud Abdel-Rasoul2, Desmond M D'Souza1
1Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
The Annals of Thoracic Surgery
|September 20, 2022
Summary
Lobectomy improves survival for stage Ia non-small cell lung cancer patients with occult lymph node disease (pN1). This finding supports lobectomy for unexpected N1 upstaging after initial wedge resection.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Sublobar resection is common for early-stage non-small cell lung cancer (NSCLC).
- Pathologic lymph node upstaging occurs frequently in these patients.
- Occult lymph node disease presents a challenge in clinical decision-making.
Purpose of the Study:
- To compare the long-term survival outcomes of patients with clinical stage Ia NSCLC and occult lymph node disease.
- To evaluate the impact of wedge resection versus lobectomy on overall survival.
- To inform surgical strategy for patients with unanticipated lymph node upstaging.
Main Methods:
- Utilized the National Cancer Database to identify patients with clinical stage Ia NSCLC.
- Included patients who underwent either wedge resection or lobectomy and were pathologically upstaged (pN1/pN2).
- Employed inverse probability treatment weighting-adjusted Cox regression to compare overall survival (OS).
Main Results:
- Lobectomy significantly improved OS compared to wedge resection for patients with occult N1 disease (median OS 70.0 vs 36.4 months).
- No significant difference in OS was observed between lobectomy and wedge resection for pN2 disease (median OS 48.2 vs 43.7 months).
- Multivariable analysis confirmed lobectomy's association with improved survival (aHR 0.73, P = .0016).
Conclusions:
- Lobectomy is associated with superior survival for clinical stage Ia NSCLC patients with occult lymph node disease.
- These findings support considering completion lobectomy for patients with unexpected N1 lymph node upstaging.
- The study provides evidence to guide surgical choices in managing early-stage NSCLC with lymph node involvement.
