Systematic review of sublobar resection for treatment of high-risk patients with stage I non-small cell lung cancer Review
| Authors: | Merritt, R. E.; Brunelli, A.; Walsh, G.; Murthy, S.; Schuchert, M. J.; Varghese, T. K. Jr; Lanuti, M.; Wolf, A.; Keshavarz, H.; Loo, B. W. Jr; Suh, R. D.; Mak, R. H.; Criner, G. J.; Mazzone, P. J.; Liptay, M.; Wafford, Q. E.; Marshall, M. B.; Tong, B.; Pettiford, B.; Rocco, G.; Luketich, J.; D'Amico, T. A.; Swanson, S. J.; Pennathur, A.; the AATS Clinical Practice Standards Committee: Thoracic Surgery |
| Review Title: | Systematic review of sublobar resection for treatment of high-risk patients with stage I non-small cell lung cancer |
| Abstract: | Sublobar resection offers a parenchymal-sparing surgical alternative to lobectomy and includes wedge resection and segmentectomy. Sublobar resection has been historically utilized in high-risk patients with compromised lung function; however, the technique is becoming more prevalent for normal-risk patients with peripheral stage IA non-small cell lung cancer (NSCLC) <2 cm. In this article, we summarize the technique of sublobar resection, the importance of surgical margins and lymph node sampling, patient selection, perioperative complications, outcomes, and the impact of sublobar resection on the quality of life. There is limited data on short-term and long-term outcomes after sublobar resection for stage I NSCLC in high-risk patients. Results from randomized clinical trials (RCTs) of sublobar resection have been variable. We have summarized the results of the ACOSOG Z4032 RCT, which compared outcomes in high-risk patients who underwent sublobar resection alone versus sublobar resection with brachytherapy for stage I NSCLC. In addition, we have summarized recent findings of the CALGB/Alliance 140503 RCT comparing sublobar resection and lobectomy, which suggested that disease-free survival after sublobar resection in patients with small (<2 cm) peripheral stage IA NSCLC was non-inferior to lobectomy, and another RCT (JCOG 0802) of segmentectomy vs. lobectomy for small peripheral clinical stage IA NSCLC, where segmentectomy was associated with better overall survival despite a higher local recurrence rate. Sublobar resection is primarily performed with minimally invasive approaches, including robotic-assisted and video-assisted thoracoscopic techniques. From an oncologic perspective, obtaining adequate surgical margins and performing an adequate lymph node evaluation are critical for good outcomes after sublobar resection. © 2024 |
| Keywords: | treatment outcome; overall survival; mortality; review; patient selection; disease free survival; cancer staging; outcome assessment; recurrence risk; lymph node dissection; neoplasm staging; lymph node excision; consensus; quality of life; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; risk factors; pathology; risk factor; high risk patient; time factors; risk assessment; postoperative complication; postoperative complications; lung tumor; systematic review; long term care; brachytherapy; surgery; lung function; perioperative complication; lobectomy; video assisted thoracoscopic surgery; non small cell lung cancer; high-risk; surgical margin; etiology; randomized controlled trial (topic); parenchyma; adverse event; time factor; wedge resection; procedures; sublobar resection; humans; human; segmentectomy; robot assisted surgery; margins of excision; expert consensus; stage i non-small cell lung cancer |
| Journal Title: | Seminars in Thoracic and Cardiovascular Surgery |
| Volume: | 37 |
| Issue: | 1 |
| ISSN: | 1043-0679 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-03-01 |
| Start Page: | 99 |
| End Page: | 105 |
| Language: | English |
| DOI: | 10.1053/j.semtcvs.2024.11.002 |
| PUBMED: | 39674442 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- Source: Scopus |
