Sublobar Resection in Early-Stage NSCLC: Thoracic Surgeon Shares Insights From New Research

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 discuss key takeaways from his research on sublobar resection in early-stage non–small cell lung cancer (NSCLC) for both patients and health care professionals.

He referred to the randomized clinical trials that were selected to inform the study data and outlined the surgical techniques highlighted by those trials that can be leveraged to combat NSCLC. He also covered the oncologic conditions that inform a clinician’s decision making when determining the optimal course of treatment for patients.

“The CALGB [Cancer and Leukemia Group B] study, which was recently published in the New England Journal of Medicine in 2023, demonstrated that sublobar resection—and that includes both wedge resection and segmentectomy—was equivalent in terms of overall survival for patients with peripheral tumors that were two centimeters or smaller,” Dr. Merritt explained.

He also compared the CALGB results to the findings of American College of Surgeons Oncology Group (ACOSOG), another international study that informed his research, emphasizing that the groundbreaking nature of the data continues to guide current clinical practice.

“The second study was from Japan, from the Japan Clinical Oncology Group, which compared just segmentectomy to lobectomy,” Dr. Merritt said. “And again, in this study, they found that the survival rate was slightly better for the segmentectomy group. However, there was a higher local recurrence rate for the segmentectomy group. Nonetheless, these are two important studies, which demonstrate that performing a less lung resection is appropriate when the tumors are two centimeters or smaller and peripherally located.”

Additional key takeaways for clinicians when they are deciding the recommended course of treatment are foundational oncologic conditions.

“That’s the key takeaway for surgeons that are performing sublobar resection, to remember those two important oncologic principles, obtaining adequate surgical margins and performing an adequate lymph node dissection,” he explained.

He concluded by highlighting how patient selection is critical to upholding these principles and promoting long-term survival while avoiding the need for additional treatments.

“In the studies, two centimeters or less was the target tumor size. Once the tumors get larger than three centimeters or two centimeters, then the outcomes really aren’t well known. The larger the tumor size, the higher the risk of a local recurrence, which could impact long-term survival and often lead to a second intervention, either another operation or radiation therapy,” Dr. Merritt said. “Also, patients that have multifocal tumors within a lobe probably aren’t good candidates for sublobar resection, and these patients should probably be considered for a lobectomy. Even though sublobar resection does have some benefits in terms of preserving lung function, it’s important to adhere to good oncologic principles.”