Segmentectomy for NSCLC: a better alternative?

Two large, multicentre, phase 3 trials, JCOG0802/WJOG4607L 1 Saji H Okada M Tsuboi M et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022; 399: 1607-1617 Summary Full Text Full Text PDF PubMed Scopus (247) Google Scholar and CALGB140503, 2 Altorki N Wang X Kozono D et al. Lobar or sublobar resection for peripheral stage IA non-small-cell lung cancer. N Engl J Med. 2023; 388: 489-498 Crossref PubMed Scopus (24) Google Scholar provided evidence that segmentectomy, as a surgical procedure, could be used without compromising oncological therapeutic outcome compared with lobectomy in early stage non-small-cell lung cancer (NSCLC) with a tumour 2 cm or less in size and a consolidation-to-tumour ratio (CTR) more than 0·5. Previous studies have also shown that sublobar resection for patients with cT1aN0 NSCLC with a predominant ground-glass opacity (GGO) is feasible in terms of pulmonary function preservation, tolerable complications, and a favourable prognosis survival (table). 3 Nakao M Yoshida J Goto K et al. Long-term outcomes of 50 cases of limited-resection trial for pulmonary ground-glass opacity nodules. J Thorac Oncol. 2012; 7: 1563-1566 Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar , 4 Tsutani Y Miyata Y Nakayama H et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest. 2014; 145: 66-71 Summary Full Text Full Text PDF PubMed Scopus (237) Google Scholar , 5 Cho JH Choi YS Kim J Kim HK Zo JI Shim YM Long-term outcomes of wedge resection for pulmonary ground-glass opacity nodules. Ann Thorac Surg. 2015; 99: 218-222 Summary Full Text Full Text PDF PubMed Scopus (87) Google Scholar , 6 Sagawa M Oizumi H Suzuki H et al. A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity. Eur J Cardiothorac Surg. 2018; 53: 849-856 Crossref PubMed Scopus (35) Google Scholar , 7 Suzuki K Watanabe S-I Wakabayashi M et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg. 2022; 163: 289-301.e2 Summary Full Text Full Text PDF PubMed Scopus (90) Google Scholar , 8 Qi Y-F Qiu Z-B Zhang C et al. Sublobectomy for stage IA1–2 invasive lung adenocarcinoma with consolidation tumor ratio≤ 0·25. Thorac Cancer. 2022; 13: 3174-3182 Crossref PubMed Scopus (1) Google Scholar However, the efficacy and safety of segmentectomy for tumours more than 2 cm in size still needs to be identified. TableSummary of studies on sublobar resection of stage IA non-small-cell lung cancer with a CTR of 0·5 or less Study design Study phase Sample size Inclusion criteria Surgical type Postoperative pulmonary function Postoperative complications Outcomes Nakao et al (2012) 3 Nakao M Yoshida J Goto K et al. Long-term outcomes of 50 cases of limited-resection trial for pulmonary ground-glass opacity nodules. J Thorac Oncol. 2012; 7: 1563-1566 Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar Prospective study NA 40 ≤2 cm tumour size, CTR ≤0·50 Sublobar resection (n=26) vs lobectomy (n=14) NA NA 5-year relapse-free survival, 100% in both groups Tsutani et al (2014) 4 Tsutani Y Miyata Y Nakayama H et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest. 2014; 145: 66-71 Summary Full Text Full Text PDF PubMed Scopus (237) Google Scholar Retrospective study NA 239 ≤3 cm tumour size, CTR ≤0·50 Sublobar resection (n=149) vs lobectomy (n=90) NA NA 3-year relapse-free survival: sublobar resection, 97·7% vs lobectomy, 96·4%; 3-year overall survival: sublobar resection, 98·5% vs lobectomy, 97·6% Cho et al (2015) 5 Cho JH Choi YS Kim J Kim HK Zo JI Shim YM Long-term outcomes of wedge resection for pulmonary ground-glass opacity nodules. Ann Thorac Surg. 2015; 99: 218-222 Summary Full Text Full Text PDF PubMed Scopus (87) Google Scholar Retrospective study NA 71 ≤3 cm tumour size, CTR ≤0·25 Wedge resection NA NA 5-year relapse-free survival, 100%; 5-year overall survival, 100% Sagawa et al (2018) 6 Sagawa M Oizumi H Suzuki H et al. A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity. Eur J Cardiothorac Surg. 2018; 53: 849-856 Crossref PubMed Scopus (35) Google Scholar Prospective study NA 72 ≤2 cm tumour size, CTR ≤0·25 Sublobar resection Postoperative average change in ratio of FEV1: by 3 months, 0·86, and by 1 year 0·96; vital capacity: by 3 months, 0·86, and by 1 year, 0·96 NA 5-year disease-specific survival, 100%; 5-year overall survival, 98·1% Suzuki et al (2022) 7 Suzuki K Watanabe S-I Wakabayashi M et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg. 2022; 163: 289-301.e2 Summary Full Text Full Text PDF PubMed Scopus (90) Google Scholar Prospective study 3 325 ≤2 cm tumour size, CTR ≤0·25 Sublobar resection Change from baseline median FEV1: −0·045 (IQR −0·37 to 0·49); forced vital capacity: −0·026 (−0·47 to 0·40) Grade 2 rate, 37·2%; grade 3 rate, 5·1% 5-year relapse-free survival, 99·7%; 5-year overall survival, 99·4% Qi et al (2022) 8 Qi Y-F Qiu Z-B Zhang C et al. Sublobectomy for stage IA1–2 invasive lung adenocarcinoma with consolidation tumor ratio≤ 0·25. Thorac Cancer. 2022; 13: 3174-3182 Crossref PubMed Scopus (1) Google Scholar Retrospective study NA 100 ≤2 cm tumour size, CTR ≤0·25 Sublobar resection (n=49) vs lobectomy (n=51) NA Sublobar resection, 2·0% vs lobectomy, 5·9% (p=0·62) 5-year lung cancer-specific overall survival, 100%; 5-year lung cancer-specific relapse-free survival, 100% in both groups CTR=consolidation-to-tumour ratio. NA=not available. Open table in a new tab CTR=consolidation-to-tumour ratio. NA=not available. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trialSegmentectomy should be considered as part of standard treatment for patients with predominantly GGO NSCLC with a tumour size of 3 cm or less in diameter, including GGO even if it exceeds 2 cm. Full-Text PDF