Clinical Considerations Surrounding Sublobar Resection in NSCLC: Dr. Merritt Discusses Recent Review

Robert E. Merritt, MD, MBA, FACS, of The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, joined Lung Cancers Today to share an overview of his systematic review on sublobar resection for patients identified as high risk and diagnosed with early-stage non–small cell lung cancer (NSCLC).

He detailed what clinical trials have shown about sublobar resection versus lobectomy and why it’s important to explore and consider the choice on case-by-case basis for each patient.

“Patients with compromised lung function cannot tolerate a pulmonary lobectomy,” Dr. Merritt explained. “Sublobar resection offers an alternative for those patients to be able to undergo a surgical resection for their early-stage lung cancer. The other important reason why sublobar resection should be studied and utilized, is it saves lung tissue, particularly in patients who have small lung cancers that are in the peripheral location.”

He noted that preserving lung tissue is especially important for patients who lead active lifestyles and want to maintain as much lung function as possible.

Dr. Merritt also outlined the selection process for identifying high-impact randomized clinical trials to inform the systematic review. The research team pulled trials that currently guide clinical practice, while directly comparing sublobar resection to lobectomy.

“Some of the studies were single-institution retrospective studies, but there were three critical randomized controlled clinical trials that were multi-institution, and these are probably the most significant studies that guide our clinical practice,” he said.

While these surgical techniques can be utilized to improve patients’ quality of life, there are also clinical considerations surrounding the decision to recommend sublobar resection versus lobectomy and other techniques.

“For patients with lung dysfunction, such as COPD or emphysema, these patients often have limited pulmonary reserve. So, performing a lobectomy would subject them to significant postoperative complications and possibly respiratory failure. It’s an important concept, which all thoracic surgeons should be aware of and able to perform these procedures,” Dr. Merritt said.