2024 CR Forum Top Ten| Lobar/Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer

Surgical treatment of early-stage small-sized lung cancer (1 inch) had traditionally been the removal of the entire lobe of the lung (lobectomy) containing the cancer. This recommendation was based on studies done in the 1960s and late 1980s. In 2005 we proposed a clinical trial challenging this recommendation. Through a National Cancer Institute-funded trial, patients with small lung cancers near the outer surface of the lung were randomly selected to have either a lobectomy or to remove a smaller section of the lobe by either a wedge resection or segmental resection. Between October 2007 and March 2017, 697 patients were included in the trial: 357 had a lobectomy and 340 had a wedge or segment resection. After 5 years, there was no difference between the two groups in survival or recurrence rates of lung cancer. The results were published in the New England Journal of Medicine in February 2023 and led to an almost immediate change in the surgical practice of treating early-stage small lung cancer around the world. Approximately 20,000-25,000 patients have stage 1 lung cancer in the United States alone, and at least half of these patients will benefit from the results of this trial. With an increase in the implementation of lung cancer screening by CT scanning, these numbers will almost certainly increase over time. Patients with lung cancer are commonly elderly with suboptimal lung function, and since lung tissue does not regenerate, patients should retain as much of their lungs as possible as long as treatment of the cancer is not compromised. Additionally, elderly patients with these early-stage tumors who might otherwise be considered inoperable because they would have needed a lobectomy, can now be offered a more conservative surgical procedure with a similar cure rate to that achievable by lobectomy.