Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer

SIMPLE SUMMARY: Lobectomy was shown to be superior to limited resection by the Lung Cancer Study Group in the surgical treatment of early staged non-small cell lung cancer (NSCLC) in 1995. Two recent non-inferiority randomized studies from the Cancer and Leukemia Group B co-operative group and the Japanese Clinical Oncology Group have compared sub-lobar resection with lobectomy and have established that sub-lobar resection was non-inferior to lobectomy for patients with clinical T1aN0 NSLC two centimeters or less. Here we review the design and results of these seminal trials and reflect on how their results may impact the treatment of NSCLC. ABSTRACT: The Lung Cancer Study Group previously established lobectomy as the standard of care for treatment of clinical T1N0 NSCLC. Advances in imaging technology and refinements in staging have prompted a re-investigation to determine the non-inferiority of sub-lobar resections to lobectomies. Two recent randomized studies, JCOG 0802 and CALGB 140503, are reviewed here in the context of LCSG 0821. The studies confirm non-inferiority for sub-lobar resection (wedge or segmentectomy) compared to lobectomy for peripheral T1N0 NSCLC less than or equal to 2 cm. Sub-lobar resection should therefore be considered the new standard of care in this sub-set of patients with NSCLC.