Sublobar Resection With Adequate Margin is Comparable to Lobectomy in Locoregional Recurrence

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Sublobar resection is standard for small peripheral non-small-cell lung cancer (NSCLC).
• Optimal margin distance for sublobar resection in NSCLC is not well-established.
• Comparing loco-regional recurrence (LRR) rates between sublobar resection and lobectomy is crucial.

Purpose of the Study:

• To evaluate the adequacy of margin distances in sublobar resections for NSCLC.
• To compare loco-regional recurrence (LRR) rates between sublobar resection with sufficient/insufficient margins and lobectomy.
• To determine the optimal surgical approach for small peripheral NSCLC based on margin status.

Main Methods:

• Retrospective review of 505 patients with completely resected (≤3 cm) NSCLC (adenocarcinoma, squamous cell carcinoma, adenosquamous cell carcinoma) between April 2018 and March 2024.
• Comparison of freedom from loco-regional recurrence (FLRR) rates and cumulative LRR risk between sublobar resection (sufficient/insufficient margins) and lobectomy groups.
• Stratified analysis for pure-solid nodules versus other subtypes.

Main Results:

• In the overall cohort, insufficient margin sublobar resection had significantly higher LRR risk than sufficient margin sublobar resection and lobectomy (5-year FLRR: 75.1% vs 95.9% vs 95.8%).
• Sufficient margin sublobar resection showed comparable LRR risk to lobectomy in the overall cohort.
• In the pure-solid nodule subgroup, both insufficient and sufficient margin sublobar resections had higher LRR risk compared to lobectomy.

Conclusions:

• Sublobar resection with sufficient margins provides local control comparable to lobectomy for NSCLC.
• An insufficient margin in sublobar resection increases loco-regional recurrence risk.
• Conventional margin distances may be inadequate for pure-solid NSCLC nodules, suggesting lobectomy or wider margins may be necessary.