Sublobar resection in nonsmall cell lung carcinoma

PURPOSE OF REVIEW: Though lobectomy remains the standard of care for resection of nonsmall cell lung cancer, a number of studies have been published in the last 24 months exploring the role of sublobar resection in the treatment of stage I nonsmall cell lung cancer. RECENT FINDINGS: Large retrospective studies comparing lobar and sublobar resection show similar overall and disease-free survival. Survival and local control for sublobar resections are best for tumors smaller than 2 cm and with margins greater than 2 cm. Importantly, sublobar resections commonly have less thorough nodal dissection and incomplete pathologic staging; this may have important therapeutic consequences. No formal comparison of segmentectomy to wedge resection has been performed although bias towards segmentectomy resulting in better outcomes than nonanatomic wedge resection continues. Sublobar resection is especially interesting for patients with prior resection, bronchoalveolar carcinoma, and the elderly. Radiologic criteria for selecting candidates appropriate for sublobar resection are evolving. SUMMARY: Sublobar resection is an alternative therapy for stage I nonsmall cell lung cancer for patients with physiologic impairment unable to undergo lobectomy. The literature also suggests a role for patients with prior lung resection, bronchoalveolar carcinoma, peripheral tumors less than 2 cm, and for the elderly.