So Now We Know-Reflections on the Extent of Resection for Stage I Lung Cancer
Document Type
Journal Article
Publication Date
5-1-2024
Journal
Clinical lung cancer
Volume
25
Issue
3
DOI
10.1016/j.cllc.2023.12.007
Keywords
Lobectomy; Randomized Trials; Segmentectomy; Survival; Wedge resection
Abstract
Lobectomy has been the standard treatment for stage I lung cancer in healthy patients, largely based on a randomized trial published in 1995. Nevertheless, research has continued regarding the role of sublobar resection. Three additional randomized trials addressing resection extent in healthy patients have recently been published. These 4 trials involve differences in design, eligibility, interventions, and intraoperative processes. Patients were ineligible if intraoperative assessment demonstrated stage > IA or inadequate resection margins. All trials consistently show no differences in perioperative morbidity, mortality, and postoperative changes in lung function between sublobar resection and lobectomy-consistent with other nonrandomized evidence. Long-term outcomes are generally encouraging of lesser resection, but some inconsistencies are apparent. The 2 larger recent trials demonstrated no overall survival difference while the others suggested better survival after lobectomy versus sublobar resection. Recurrence-free survival was found to be the same after lobectomy versus sublobar resection in 3 trials, despite higher locoregional recurrences after sublobar resection. The low 5-year recurrence-free survival (64%, regardless of resection extent) in 1 recent trial highlights the need for further optimization. Thus, there is high-level evidence that sublobar resection is a reasonable alternative to lobectomy in healthy patients. However, variability in long-term results suggests that aspects of patients, tumors and interventions need to be better understood. Therefore, we propose to apply sublobar resection cautiously; especially because there are no short-term benefits. Sublobar resection requires careful attention to intraoperative details (nodes, margins), and may be best suited for less aggressive (eg, ground glass, slow growing) tumors.
APA Citation
Detterbeck, Frank; Ely, Sora; Udelsman, Brooks; Blasberg, Justin; Boffa, Daniel; Dhanasopon, Andrew; Mase, Vincnet; and Woodard, Gavitt, "So Now We Know-Reflections on the Extent of Resection for Stage I Lung Cancer" (2024). GW Authored Works. Paper 5019.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5019
Department
Surgery