Lobectomy or sublobar resection?—Comparative analysis of the techniques in the surgical treatment of non-small cell lung cancer: a narrative review

Abstract

The aim of the study is to compare two techniques in the surgical treatment of resectable nonsmall cell lung cancer (NSCLC).Background: Minimally invasive surgery is the gold standard in the treatment of lung cancer in the early stage. This strategy is not only related to the reduced surgical access but also to the amount of parenchyma that must be saved, compatibly with the oncological radicality. The purpose of the study is to evaluate if sublobar resection can be a valid alternative to lobectomy, based on results.Methods: We carried out a systematic analysis of the studies conducted in literature in the last 6 years (from 2015 to 2021), comparing the outcomes of lobectomies and sublobar resections (segmentectomy or wedge).The parameters considered were as follows: complications, relapse rate and overall survival. Lobectomy showed a slightly higher risk of developing complications than sublobar resection, especially in octogenarian or in a high index of comorbidity (0-48% vs. 0-46.6%, respectively). Conversely, the relapse rate (2.3-32% vs. 2.9-53.4%) and overall survival (45.9-93.8% vs. 33.8-100%) were more favorable in patients treated with lobectomy although sublobar resection showed an increasing survival rate over the years.Conclusions: From the review of literature, lobectomy is still the safest oncologically method to treat the bronchogenic carcinoma. Regarding sublobar resections, there is no clear and distinct classification of results between anatomical segmentectomy and wedge resection. More multicenter randomized studies would be needed in order to compare the three techniques separately.