SOME patients undergoing traditional ‘lobectomy’ surgery, where an entire lobe is removed, for early-stage lung cancer, may benefit from ‘sub-lobar resection’ surgery, which removes only a portion of one of the five lobes. These findings come from a Phase 3, multicentre clinical trial conducted from 2007–2017 across 93 clinical centres in the USA, Canada, and Australia.
Every year, over 2 million people across the world are diagnosed with lung cancer, the majority of whom have non-small cell lung cancer (NSCLC). In the earliest stage, when the tumour is small and localised, NSCLC is frequently treated with surgery alone. A prominent 1995 clinical study, which compared lobectomy to sub-lobar surgery in patients with early-stage lung cancer, found 50% higher mortality and triple the rate of tumour recurrence in the patients who underwent sub-lobar surgery. As a result, lobectomy surgery was established as the standard surgical procedure for NSCLC. Major advancements in imaging and determining cancer stage have increased detection of smaller, early-stage lung tumours, thereby raising concerns about whether lobectomy is the best standard for these cases.
Approximately 700 patients with early-stage lung cancer were randomly assigned into two groups. Inclusion criteria included a tumour with a size no larger than 2 cm, in the outer third of the lungs, and without lymph node involvement. One group underwent lobectomy surgery, while the other group had sub-lobar surgery, and they were tracked for a median of 7 years after surgery. The rates of disease-free and overall survival, as well as tumour recurrence, were similar in both groups. Researchers noted that the sub-lobar group had slightly better lung function.
The researchers highlighted that lobectomy surgery has been the standard approach to early-stage lung cancer surgery for almost 30 years. “This is a practice-changing study,” said the lead author Dr. Nasser Altorki, chief of thoracic surgery at New York-Presbyterian/Weill Cornell Medical Centre in New York City, USA. In a Weil Cornell news release, Altorki added: “we’re pretty confident that these results are real, and they tell us that patients do not always have to have a full lobe of their lungs removed to cure their cancer.” Along with the other benefits associated with removing less lung tissue, the study authors advocated for the use of sub-lobar resection as the new standard for early-stage cancers of this type.