Real-World outcomes of limited resection for tumors greater than 20 mm in non-small cell lung cancer

Abstract Objectives Sublobar resection is an established surgical option for early-stage non-small cell lung cancer. However, evidence remains limited regarding its use for tumors >20 mm in real-world settings. We evaluated characteristics and outcomes of limited resection in this context and identified predictors of local recurrence. Methods We retrospectively analyzed 165 patients with clinical stage I non-small cell lung cancer with tumors >20 mm who underwent limited resection between 2007 and 2017. Clinical, pathological, and radiological data were reviewed. The primary end-point was local recurrence, assessed using competing risk analysis. Overall survival and disease-free survival were estimated using Kaplan–Meier and Cox models. Results We analyzed 165 patients with 13 local recurrence events. Among them, 146 (88.5%) had identifiable reasons for not undergoing lobectomy. Segmentectomy and wedge resection were performed in 59% and 41% of cases, respectively. Lymph node dissection was performed in all segmentectomies and in 20% of wedge resections. The five-year overall and disease-free survival rates were 64.0% and 62.1%. Local recurrence occurred in 8%, more frequently after wedge resection than segmentectomy (13% vs 4%, p = 0.04). Solid-predominant tumors with a consolidation-to-tumour ratio greater than 0.5 accounted for 76% and were independently associated with lower disease-free survival (hazard ratio, 2.65; p = 0.05) and higher local recurrence (hazard ratio: infinite; p < 0.001). No local recurrence was observed in tumors with a ground-glass opacity–predominant pattern. Conclusions Limited resection showed acceptable outcomes in lung cancers >20 mm, especially with ground-glass opacity; solid-predominant CT patterns were strongly linked to recurrence.