Less Extensive Surgery Is Just as Effective as Full Lobe Removal for Some Early Lung Cancers

Dr. Thomas Bauer, Jersey Shore University Medical Center Chairman of Surgery, was a lead author of a multicenter international clinical trial showing that removing only the part of a lung containing an early-stage lung cancer was as effective as removing the entire lung lobe, without compromising the risk of recurrence or overall survival.

Could Change the Standard of Care

The findings of the phase 3 study, published in the February 9, 2023, issue of the New England Journal of Medicine, have the potential to change the standard of care for select patients with small cancers in the lung periphery that have not spread beyond their original location.

“The results of this clinical trial may change the way we manage early-stage lung cancer. We also witnessed a trend toward better respiratory function in patients who had less lung tissue removed, which could be especially beneficial for people with compromised pulmonary function.” -- Thomas L. Bauer, M.D., MBA, chairman of surgery at Jersey Shore University Medical Center and one of the study’s lead authors.

Effective Surgical Treatment

In this study, researchers randomly assigned 697 patients with peripheral stage 1, node-negative NSCLC (primarily adenocarcinomas and squamous cell carcinomas) to undergo either lobectomy (357 patients) or sublobar resection (340 patients). All patients had tumors that were 2 cm or less in size. After a median follow-up of 7 years, the rate of recurrence and overall survival were similar between the two groups. The rate of recurrence at 5 years (disease-free survival) was 64.1% after lobectomy and 63.6% after sublobar resection; 5-year overall survival rates were 78.9% and 80.3%, respectively. Patients in the sublobar resection group had forced expiratory volume rates (a measure of lung function) that were 2 percentage points better than the lobectomy group. Forced vital capacity, another measure of respiratory function, was also slightly better for the sublobar resection patients. The authors concluded that sublobar resection is an effective surgical treatment for people with stage 1 node-negative NSCLC and small tumors. They added that these findings will become increasingly relevant as the proportion of patients with early-stage lung cancer increases with expanded implementation of lung cancer screening, and as the number of older patients with early-stage disease in whom sublobar resection may be the preferred surgical approach rises.