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

Hackensack Meridian Jersey Shore University Medical Center Chairman of Surgery Dr. Thomas Bauer Is Part of the International Multicenter Research Team

Hackensack Meridian Jersey Shore University Medical Center investigators were part of a multicenter international clinical trial showing that removing just 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. 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 are very important and may change the way we manage early-stage lung cancer,” explained Thomas L. Bauer, M.D., MBA, chairman of surgery at Jersey Shore University Medical Center, who was one of the study’s lead authors. “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.”

Lobectomy — removal of a lung lobe — has been the standard surgical approach for patients with stage 1 non-small cell lung cancer (NSCLC) that has not spread to the nearby lymph nodes or other parts of the body. But newer imaging and staging methods, including lung cancer screening with low-dose CT scanning, have led to the detection of smaller and earlier tumors. Surgeons have questioned if some of these patients can undergo sublobar resection (removal of just the tumor and some tissue around it, rather than the whole lung lobe) without compromising their outcomes.

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.

For information about thoracic surgery services at Jersey Shore University Medical Center, visit www.hackensackmeridianhealth.org/en/Services/Surgical-Services/Thoracic-Surgery.