Sublobar resection for lung cancer

Abstract

Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged .71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of f2 cm, segmentectomy is equivalent to lobectomy, but survival after segmentectomy is worse if performed for larger tumours. For both segmentectomy and wedge resection, tumour margins should be o1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of f2 cm, diagnosed intraoperatively with certainty, sublobar resection seems equivalent to lobectomy, and because there is no nodal involvement, systematic nodal dissection may not be necessary. In case of doubt, however, lobectomy with systematic nodal dissection will ensure complete resection and adequate staging. More randomised trials are needed to confirm all these issues.

How to deal with subcentimeter lung cancer: a moving target!

“…Many retrospective studies mainly coming from Japan, showed that for small, early NSCLC sublobar resection may be an oncologically valid procedure, also for low risk patients who might tolerate a major lung resection. In a review of sublobar resection segmentectomy yielded similar results as lobectomy for tumors ≤2 cm (20). In a meta-analysis of sublobectomy versus lobectomy published in 2012 similar results for overall survival were found for stage IA NSCLC ≤2 cm with a hazard ratio of 0.81 (21).…”

The lobar vs. sublobar “limited” resection respiratory function preservation debate: learning to speak the same language

“…That study was, however, criticized due to inconsistencies regarding the collection of data; several non-anatomical resections (wedges) were included in the "limited" resection group, which may have altered the overall outcome of the study. More importantly, the aforementioned study unfortunately shed light on the discrepancies and the multitude of variables among data investigated and reported in different studies (7,(9)(10)(11)(12).…”

“…These two types of resections are distinctly different, both in technical and oncological features (7,10). Additionally, the amount of parenchyma removed per case may vary.…”

“…It is different when dealing with patients with low FEV1 and FVC, due to COPD compared to dealing with patients presenting with apical predominant emphysema with a high TLC and RV, who would benefit from a larger parenchymal resection (lobectomy) mimicking a LVRS (7,25,26).…”

“…The quest to support the implementation of the limited resection into the cancer surgery armamentarium started many years ago. However, the concern with lung-sparing and minimal access techniques is that the oncological outcome may be compromised (6,7).…”