Sublobar resection for early-stage lung cancer: the issue of safety margins

The article by Akamine et al. [1] published in this issue of the journal comes at a time when the thoracic surgery community is questioning the optimal surgical treatment of early-stage NSCLC, after the final results of the JCOG 0802 trial [2] and the partial results of the CALBG/Alliance 140503 trial. Things seemed pretty clear with the conclusion of the JCOG 0802 trial recommending anatomical segmentectomy over lobectomy because—despite a significantly higher recurrence rate in the segmentectomy group—survival was significantly better than for lobectomies [2]. The CALBG 140503 trial shows equivalent survival between sublobar resection (SLR) and lobectomy but the SLR group includes segmentectomies and wedge resections. However, as there are more wedge resections than segmentectomies in the SLR arm, the temptation is to assume that the results apply to wedges. At the time of writing this commentary, we are awaiting the final results and do not have a subgroup analysis.