Sublobar Resection for Early-Stage Lung Cancer

The use of sublobar resection techniques (anatomic segmentectomy; extended wedge) in the treatment of early-stage non-small cell lung cancer has been associated with increased local recurrence rates compared with lobectomy. Recent data, however, have suggested that sublobar resection of smaller tumors (especially those ≤2 cm) can be performed with no significant difference in local recurrence or long-term survival. These findings have particular relevance in elderly patients and in those patients who may be at high risk for lobectomy because of underlying medical comorbidities. Careful patient selection on the basis of individualized assessment of specific patient and tumor characteristics will aid in selecting the optimal approach. For larger tumors, or when adequate surgical margins are not obtainable, lobectomy should be performed. Currently, active, prospective, randomized studies (Cancer and Leukemia Group B [CALGB] 140503 and American College of Surgeons Oncology Group [ACOSOG] Z4032) will provide critical insights in delineating the efficacy of sublobar resection techniques in early-stage non-small cell lung cancer.