Sublobar Resection Produces Similar Outcomes to Lobectomy in Early NSCLC

Outcomes were similar for patients who underwent sublobar resection and those who underwent more invasive lobectomy for early-stage non–small cell lung cancer (NSCLC), according to a study published in The New England Journal of Medicine.¹ The findings suggest that sublobar resection can be an effective management approach while preserving functional lung tissue for certain patients.

"It's great to know that we can safely offer our patients a procedure that allows for the preservation of functional lung tissue as long as patients are properly staged and the surgical team has the necessary experience," said lead study author Everett Vokes, MD, a medical oncologist at University of Chicago Medicine, in a statement.²

Lobectomy, which entails removing an entire lung lobe, has been the standard of surgical care for clinical stage T1N0 NSCLC for decades, but advancements in imaging and staging have facilitated the detection of smaller tumors earlier on, the authors wrote. Sublobar resection, which only removes the tumor and surrounding tissue, could therefore be feasible in some patients with early-stage NSCLC who would otherwise be recommended for more invasive lobectomy.

The study enrolled patients with suspected or confirmed stage T1aN0 NSCLC at 83 participating institutions between June 2007 and March 2017. A total of 697 preregistered patients were eligible based on preoperative and intraoperative eligibility criteria and were randomized to undergo either sublobar resection (n = 340) or lobar resection (n = 357). In the sublobar resection cohort, 59.1% (n = 201) underwent wedge resection and 37.9% (n = 129) underwent anatomical segmental resection.

The median follow-up was 7 years, and patients who underwent sublobar resection had similar disease-free survival (DFS) to those who underwent lobectomy (HR, 1.01; 90% CI, 0.83-1.24). Five-year DFS was 63.6% (95% CI, 57.9%-68.8%) in patients who underwent sublobar resection and 64.1% (95% CI, 58.5%-69.0%) among those who underwent lobectomy.

Overall survival (OS) was also similar between the sublobar resection and lobectomy cohorts (HR, 0.95; 95% CI, 0.72-1.26). Five-year OS was 80.3% (95% CI, 75.5%-84.3%) in the sublobar resection cohort was and 78.9% (95% CI, 74.1%-82.9%) in the lobectomy cohort.

“In a post hoc exploratory analysis, results were generally consistent between the overall analysis and subgroup analyses defined by key demographic and clinical variables, including age group, sex, tumor location, histologic type, smoking history, tumor size, and ECOG performance-status score,” the authors wrote.

At 6 months post procedure, patients who underwent sublobar resection had a slightly improved percentage of predicted forced expiratory volume in 1 second, an indicator of lung function, compared with the lobectomy cohort.

The findings are in line with recent trial results from the Japanese Clinical Oncology Group, which suggest that anatomical segmentectomy was noninferior to lobectomy in a similar patient population,³ the authors noted. The current study found that wedge resection and anatomical segmental resection led to similar outcomes.

“Together, these findings affirm that sublobar resection for patients with clinical T1aN0 disease by either anatomical segmentectomy or wedge resection is an effective management approach for this subgroup of patients with NSCLC,” the authors concluded.

References

1. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage IA non-small-cell lung cancer. N Engl J Med. 2023;388(6):489-498. doi:10.1056/NEJMoa2212083

2. New study supports saving more lung tissue in lung cancer surgeries. News release. UChicago Medicine. March 22, 2023. Accessed April 4, 2023. https://www.uchicagomedicine.org/forefront/cancer-articles/new-study-supports-saving-more-lung-tissue-in-lung-cancer-surgeries

3. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617. doi:10.1016/S0140-6736(21)02333-3