Outcomes of Lobectomy vs Sublobar Resection for Clinical Stage IA3 Non-Small Cell Lung Cancer

Recent trials demonstrate comparable outcomes between sublobar resection (SLR) and lobar resection (LR) for stage IA1-2 (≤2 cm) non-small cell lung cancer (NSCLC). Conversely, historical studies reported more recurrences with SLR than with LR for stage IA3 NSCLC (>2 cm, ≤3 cm), although these investigations predated diagnostic and therapeutic advancements. We aimed to compare SLR and LR outcomes in these patients in the contemporary era.

Patients assigned to clinical stage IA3 NSCLC undergoing resection at a single institution (2015-2024) were stratified by wedge resection, anatomic segmentectomy, or LR. Patients with neoadjuvant therapy receipt and neuroendocrine tumors were excluded. Outcomes were evaluated by Kaplan-Meier and multivariable Cox regression models.

We identified 260 individuals: 40 (15.4%) underwent wedge resection, 67 (25.8%) segmentectomy, and 153 (58.8%) LR. Most patients were male (wedge, n = 14/40 [35.0%]; segmentectomy, n = 30/67 [45.0%]; LR, n = 65/153 [42.5%]; P = .59). Groups differed in median number of lymph nodes harvested (wedge, 6 [4-8]; segmentectomy, 11 [7-15]; LR, 14 [9.5-18.5]; P < .01). Recurrences were more frequent after wedge resection (wedge, n = 11/40 [27.5%]; segmentectomy, n = 11/67 [16.4%]; LR, n = 18/153 [11.8%]; P = .04). At median follow-up (42.8 months), 3-year disease-free survival for wedge resection patients was 76.8% (95% CI, 63.7-92.7) compared with 82.7% (95% CI, 73.4-93.1) for segmentectomy patients and 90.9% (95% CI, 85.8-96.2; P = .03) for LR patients.

LR and segmentectomy achieved comparable outcomes in stage IA3 NSCLC, whereas wedge resection was associated with higher recurrence and inferior disease-free survival. These data contribute to discussions about the role of SLR in treating this subgroup of patients.