Lobectomy Versus Sublobar Resection for Small (2 cm or Less) Non–Small Cell Lung Cancers

doi:10.1016/j.athoracsur.2011.06.099

The Annals of Thoracic Surgery

Volume 92, Issue 5, November 2011, Pages 1819-1825

Presented at the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.

https://doi.org/10.1016/j.athoracsur.2011.06.099 Get rights and content

Background

We evaluated a cohort of patients who underwent resection for small (2 cm or less) non–small cell lung cancer (NSCLC) to determine if there is an association between extent of resection (lobar versus sublobar resection) and local recurrence or survival.

Methods

We reviewed 468 consecutive patients who underwent resection for small NSCLC at our institution between 2000 and 2005. We excluded patients who had neoadjuvant therapy, active noncutaneous malignancies, pure bronchioalveolar carcinoma, lymph node (n = 53) or distant metastases at diagnosis, or multicentric cancers. Clinicopathologic data, recurrence, and vital status as of June 15, 2010, were retrieved. Overall and recurrence-free survival from surgery rates were assessed.

Results

Two hundred thirty-eight patients underwent resection for primary solitary small NSCLC. Lobectomy (n = 84) was associated with longer overall (p = 0.0027) and recurrence-free (p = 0.0496) survival. Patients who underwent sublobar resection were older (p < 0.0001) and had worse pulmonary function (p < 0.0014). While there was a trend toward increased rate of local recurrence for sublobar resection (16% versus 8%, p = 0.1117), there was no difference in distant recurrence. Moreover, when lymph nodes were sampled with sublobar resection, local recurrence rate and overall and recurrence-free survival distributions were similar to those for lobectomy.

Conclusions

Sublobar resection is reasonable in older patients with limited cardiopulmonary function. For healthy patients, however, lobectomy remains the standard therapy, with sublobar resection with lymph node sampling representing an alternative to consider. These findings support continued effort to conduct a randomized trial of lobar versus sublobar resection, such as CALGB 140503.

Section snippets

Patients and Methods

With institutional review board approval, we reviewed the records of all patients who underwent resection for NSCLC tumors of 2 cm or less at our institution between January 1, 2000, and December 31, 2005. Of these 468 consecutive patients, we excluded patients who had neoadjuvant therapy, other active noncutaneous malignancies, pure bronchioalveolar carcinomas (BAC), lymph node (n = 53) or distant metastases at diagnosis, or multicentric cancers. Electronic and written records were reviewed

Results

There were 238 patients who underwent resection for primary solitary NSCLC of 2 cm or less at our institution between 2000 and 2005 and who met study criteria for inclusion. There were 154 sublobar resections, including 24 segmentectomies. There were 66 (43%) sublobar resections performed via a video-assisted thoracoscopic (VATS) approach versus 8 (10%) lobectomies (p < 0.0001). Compared to patients who underwent lobectomy, patients who underwent sublobar resection were older and had worse

Comment

These data demonstrate that for pulmonary resection of solitary NSCLC tumors of 2 cm or less, recurrence rates were not significantly different for patients who underwent sublobar resection (wedge resection and segmentectomy combined) compared to those who underwent lobectomy, but lobectomy was associated with a trend toward lower rate of local recurrence. Moreover, overall and recurrence-free survival rates were significantly longer for patients treated with lobectomy. When lymph nodes were

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Original articleGeneral thoracicLobectomy Versus Sublobar Resection for Small (2 cm or Less) Non–Small Cell Lung Cancers

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comment

J Thorac Cardiovac Surg

Chest

Chest

J Thorac Cardiovasc Surg

Ann Thorac Surg

Original article
General thoracic
Lobectomy Versus Sublobar Resection for Small (2 cm or Less) Non–Small Cell Lung Cancers