Advancements in lung cancer diagnosis, staging, and treatment, and sublobar resection outcomes have improved over decades. For a long time, lobectomy was the standard gold therapy for early-stage lung cancer. Stub-lobar resection has been shown to enhance survival rates and oncologic outcomes on par with lobectomy when performed on the right individuals.
This necessitates a reconsideration of the current standard of therapy for peripheral stage IA lung tumors. Despite advances in thoracic oncology over the last few decades, surgical resection remains the standard gold therapy for patients with early-stage lung cancer who do not face an unacceptable risk from surgery.
The Lung Cancer Study Group determined that lobectomy is better for sublobar resection in terms of overall survival (OS) and recurrence isk. However, tremendous progress has been achieved in detecting and treating lung cancer since the release of the LCSG’s randomized study in 1995. Because of the growing usage and more excellent resolution of computed tomography (CT) scans, smaller and non-solid lung nodules have been discovered; PET CT, EBUS, and mediastinoscopy have improved clinical staging and diagnosis; and there are more thoracic surgeons.
As per research published in the Frontiers, people might be contemplating lobectomy or sublobar resection if they have a stage IA lung tumor. Some of the advantages of lobectomy include a lower risk of local recurrence, improved parenchymal margins, complete lymphatic clearance and sampling, and a longer overall and disease-free life (DFS). Patients with little pulmonary reserve or those requiring recurrent resections may benefit from segmentectomy or wedge resection due to the possibility of preserving lung parenchyma.
As per New England Journal of Medicine, several research, primarily retrospective, have investigated the consequences of sublobar excision. It is advised that for patients who would ordinarily be candidates for lobectomy, sublobar resection has yet to be the primary focus of these trials.
Patients receiving sublobar resection were more likely to be older, have a less cardiopulmonary reserve, have other concurrent comorbidities, or have incorrectly staged lesions, all of which were features shared by the majority of previous investigations. Methodological issues such as inadequate margins, resections performed by non-specialist surgeons, and inconsistent or insufficient lymph node sampling have muddled the results.
Despite efforts to account for selection bias by propensity matching, which creates the sense of a trustworthy comparison, the contemporary urge for massive database mining is not without complications. Recent trials have shown that sublobar resection improves outcomes for stage IA lung cancer. However, these studies excluded individuals with comorbidities who would be candidates for lobectomy or sublobar resection.
This research supports the hypothesis that segmentectomy and wedge resection should be used more often to treat early-stage lung cancer. Patients who receive a meticulous examination by a thoracic surgeon with sublobar excision skills have a good chance of a favorable oncologic outcome.
A careful patient selection and an in-depth examination of the patient’s functional level, comorbidities, and anatomic factors are required for successful lung cancer resection. Because of advances in clinical staging and detection, sublobar resection rather than lobectomy should be regarded as a viable, and in some circumstances preferred, option in the setting of small, peripheral stage IA lung cancer.
Both segmentectomy and wedge resection are effective treatments for stage IA lung cancer. Many recent studies have shown that sublobar resection is as adequate as lobectomy in terms of overall survival and disease-free survival (OS and DFS), provided the patients are appropriately selected.
Sublobar resection provides various advantages, including preservation of lung function, decreased perioperative morbidity and mortality, and preservation of lung parenchyma, which may allow for further resections in an era with more detected multifocal ground glass opacities.
The NCCN non-small cell lung cancer recommendations thoroughly explain surgical therapy concepts, including the possibility of sublobar resection. The preferred surgical approach for treating lung cancer is anatomic pulmonary resection. A segmentectomy or wedge resection is considered appropriate in patients with poor pulmonary reserve or other severe comorbidities if a complete resection with excellent margins and lymph node sampling/dissection can be done.
Sublobar excision may also be helpful for patients with less than 2 cm peripheral lung nodules that are less than 50% solid, have pure adenoma-in-situ histo, logy, or have a radiologic doubling time of fewer than 400 days. The National Comprehensive Cancer Network recommends parenchymal resection margins greater than 2 cm or the size of the nodule, as well as frequent sample or dissection of relevant N1 and N2 lymph nodes (NCCN).
