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Is Sublobar Resection Optimal for Peripheral Nodules ≤2 cm with Micropapillary or Solid Histologic Components?

Yuanyuan Xu¹, Zhongjie Wang², Hanbo Pan¹

¹Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China.

The Annals of Thoracic Surgery

|February 27, 2026

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For small lung adenocarcinomas with high-risk features, lobectomy showed better recurrence-free survival (RFS) and lung cancer-specific survival (LCSS) than sublobar resection. Further prospective studies are needed to confirm these findings.

Area of Science:

Thoracic Surgery
Surgical Oncology
Pulmonary Medicine

Background:

Optimal resection extent for small peripheral nonmucinous invasive lung adenocarcinoma with high-risk histology is unclear.
Sublobar resection is gaining acceptance, but its efficacy for tumors with micropapillary or solid components needs definition.

Purpose of the Study:

To compare outcomes of lobectomy versus sublobar resection for specific lung adenocarcinomas.
To evaluate the impact of histologic features on survival after different resection types.

Main Methods:

Retrospective cohort study of 501 patients with peripheral nonmucinous invasive lung adenocarcinoma (≤2 cm, pN0M0) with high-risk histology.
Analysis of recurrence-free survival (RFS) and lung cancer-specific survival (LCSS) using Kaplan-Meier and Cox models.

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Propensity-score matching to control for baseline patient and tumor characteristics.

Main Results:

Lobectomy demonstrated significantly higher 5-year RFS and LCSS compared to sublobar resection (p<0.001).
Associations persisted after propensity-score matching.
Factors independently linked to worse outcomes included consolidation-to-tumor ratio >0.5, visceral pleural invasion, wedge resection, and segmentectomy.

Conclusions:

Lobectomy is associated with superior outcomes for ≤2 cm peripheral nonmucinous invasive lung adenocarcinomas with micropapillary or solid components.
These findings suggest lobectomy may be preferred for these high-risk tumors.
Results require validation through prospective clinical trials.