Relevance and justification of sublobar resection in early peripheral non-small cell lung cancer in the era of dominance of lobectomy

Purpose of the study

Summarizing the world experience of sublobar lung resections in early peripheral non-small cell lung cancer (NSCLC).

Materials and methods

Literature search was carried out in Medline, Elibrary and PubMed systems using 34 scientific publications on the results of surgical treatment of early peripheral NSCLC and reflecting modern aspects of both preoperative examination, volume of surgery, and immediate and long-term indicators of cancer-specific and overall survival when comparing sublobar interventions with standard radical lobectomy.

Results

The review highlights the results of international randomized trials comparing the results of treatment of radical lobectomy in early (T1N0) peripheral NSCLC with smaller operations (wedge resection, anatomical segmentectomy), both with and without lymph node dissection.Modern capabilities of computed tomography allow visualization of early forms of lung cancer, when hematogenous dissemination is not yet observed, and lymphatic spread to regional lymph nodes is casuistically rare. It is in this group of patients that one can count on the success of sublobar operations, incl. without lymph node dissection. Despite the experience already accumulated in retrospective studies conducted in several large medical centers, much remains to be learned before sublobar resections are standardized and take their place in the treatment of early NSCLC.

Abstract

Surgical treatment of lung cancer dates back to 1933, when the first pneumonectomy was performed to treat this disease. In 1952 pneumonectomy was replaced by lobectomy, which is currently the recognized global standard for operable NSCLC. Modern medical science has accumulated a huge body of clinical data, which allowed us to start a new milestone in the evolution of the surgical treatment of lung tumors, namely, a decrease in the volume of the resection stage of the operation in some early forms of peripheral lung cancer. The article analyzes the results of a number of large-scale works presented in the world literature on this topic.

The conclusions of the authors of most studies confirm the undoubted advantage of lobectomy compared to sublobar
resections in NSCLC, incl. and in early forms of this disease. Thus, radical lobectomy remains the “gold standard” for the
treatment of all resectable forms of non-small cell lung cancer today.

In fewer studies, the authors summarize the similar efficacy of sublobar resections compared to lobectomy. At the same
time, there are practically no works that would assert the advantages of sublobar resection.

The world medical literature is just beginning to accumulate experience that would allow an objective assessment of
the real possibility of reducing the volume of surgery for early forms of peripheral NSCLC. Particularly interesting in terms
of new prospects for the surgical treatment of LC are its early forms such as subsolid foci, for which, very likely, a reduced
resection volume will be justified.