Sublobar resection is the preferred surgical strategy for clinical stage IA lung cancers presenting as subsolid...

Lung cancer presenting as subsolid lesions has been described as less aggressive than solid lung cancers. Thus, lobectomy for subsolid lesions may be an overly extensive resection compared with sublobar techniques. The objective of the current study was to compare oncological differences between patients receiving lobectomy and sublobar resection for lung cancers presenting as subsolid lesions less than 3 cm.

A retrospective review of prospectively maintained databases from the International Early Lung Cancer Action Program, Initiative for Early Lung Cancer Research on Treatment, and Weill Cornell Medicine was conducted to identify lung cancers presenting as subsolid lesions treated with surgical resection. Solid lung cancers and nodules greater than 3 cm were excluded. Computed tomography imaging was used to determine the size of nodule and percent solid component. The primary outcome of interest was lung cancer-specific survival. The secondary outcomes of interest included disease-free survival and overall survival. Median duration from surgery to outcome or last follow-up was 57.7 months (interquartile range, 30.1-111.5 months).

A total of 624 patients were identified and divided into 2 groups based on extent of resection: Group A underwent lobectomy (320 patients), and group B underwent sublobar resection (304 patients). Of patients undergoing sublobar resection, 61% (185) underwent wedge resection and 39% (119) underwent segmentectomy. Nodules were further stratified by percent solid component (nonsolid, <25% solid, 25%-49% solid, >50% solid). Sixteen patients (2.56%) of the entire study population developed recurrence, and 2 patients (0.3%) had died of lung cancer. At the end of follow-up, lung cancer-specific survival was 100% in group A and 98.2% in group B (95.2-100.0) (log-rank, P = .0709). Disease-free survival in group A was 67.4% (95% CI, 57.8-77.0) and 71.1% in group B (95% CI, 59.9-82.2) (log-rank, P = .8497). Overall survival was 68.2% in group A (95% CI, 58.5-77.9) and 72.3% in group B (95% CI, 60.9-83.8) (log-rank, P = .9124). Lung cancer-specific survival and disease-free survival were not significantly different when comparing lobectomy directly with wedge resection and segmentectomy, respectively, for the entire cohort. Patients with tumors greater than 2 cm treated with sublobar resection had worse disease-free survival compared with those treated with lobectomy. Percent solid component did not significantly impact lung cancer-specific survival or disease-free survival.

In this large cohort of patients with lung cancers presenting as subsolid nodules less than 3 cm, lung cancer-specific survival was excellent and similar between lobectomy and sublobar resection. Disease-free survival was worse for patients with tumors greater than 2 cm treated with sublobar resection.