Original ResearchSublobectomy versus lobectomy for stage I non-small cell lung cancer in the elderly

- Sublobectomy might achieve similar survival rates when compared with lobectomy in elderly stage I NSCLC patients.
- Sublobectomy can be safely and effectively performed for elderly patients with early stage NSCLC.
- Sublobectomy is a reasonable option for a select set of patients who are poor candidates for lobectomy.

ObjectiveThe aim of our study was to compare the operative characteristics and long term survival for elderly patients with stage I non-small cell lung cancer (NSCLC) who underwent sublobectomy versus lobectomy.MethodsWe identified 245 consecutive elderly patients (≥65y) with pathologic stage I NSCLC who underwent lobectomy or sublobectomy at our institution between 2006 and 2012, and assessed the operative characteristics, recurrence, and survival differences between these approaches.ResultsA total of 39 patients underwent sublobectomy and 206 patients had lobectomy. There were significantly more COPD (p = 0.046) and low percent of predicted FEV1 (p = 0.034) in sublobectomy patients compared to the lobectomy group. Sublobectomy patients had significantly shorter operating time (p = 0.001), less blood loss (p = 0.000), and trended toward fewer chest tube days (p = 0.001) and shorter hospital length of stay (p = 0.030). The 1-, 3-, and 5-year survival rates in patients with lobectomy were 91.3, 77.7, and 64.1%, respectively, and has no significantly difference with those underwent sublobectomy (87.2, 74.4, and 61.5%, respectively, p = 0.623). Subgroups survival analysis showed no significant difference in the OS and DFS for patients with T < 2 cm or %FEV1<80%, but survival after sublobectomy was worse if performed on patients with larger tumours (T ≥ 2 cm) or relatively strong lung function (%FEV1≥80%).ConclusionWe concluded that sublobectomy might achieve similar survival rates when compared with lobectomy in elderly stage I NSCLC patients, especially for patients with low %FEV1 and stage IA tumours less than 2 cm in diameter.