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Removing an entire lobe of the lung might not be necessary for early stage lung cancer, according to new research published in The New England Journal of Medicine.

Nearly 700 patients with early stage non-small cell lung cancer were randomly chosen to have a lobectomy to remove an entire lobe of the lung or a sublobar resection to remove only a portion of a lobe. Results of the phase 3 clinical trial show that survival rates between the two groups were similar, but those who had only a portion of the lobe removed had better lung function.

In the 1940s and ’50s, the prevailing thought was that the only chance for a cure for lung cancer was to remove the entire lung. With the increasing use of CT scans for lung cancer screening, cancers are being diagnosed smaller and earlier. It’s no longer necessary to remove an entire lung to achieve a cure.  

Today, instead of removing a whole lobe, it’s possible to remove an even smaller portion of the lung through a sublobar resection. There are two types: A wedge resection removes a small piece of the lung, and a segmentectomy does the same but also removes the specific connected artery, vein and airway. This makes a segmentectomy more challenging.

Subsequent in-depth studies are absolutely needed specifically looking at the differences between wedge resections and segmentectomies in the context of early lung cancer.
Dr. Jacques Fontaine, Department of Thoracic Oncology

The trial evaluated participants from 2007 to 2017 at 83 centers in the United States, Canada and Australia, including Moffitt Cancer Center. Non-small cell lung cancer tumors were 2 centimeters or smaller, no lymph nodes were involved and the cancer had not spread. Tumors were in the outer third of the lungs where the risk of spread is lower. Participants were followed for a median of seven years after surgery.

The results of this latest study show the same cancer outcomes whether surgeons removed an entire lobe or less than a lobe. The lead author calls the study practice changing. But it’s still too soon to give the green light to all surgeons in the United States to perform wedge resections for early stage lung cancer.

“The CLGB study is a landmark study and confirms results from a previously published Japanese study, but the results show that a sublobar group had a mixture of patients who had a simpler wedge resection and a technically more challenging segmentectomy resection,” said Dr. Jacques Fontaine, thoracic surgeon in Moffitt’s Department of Thoracic Oncology. “Subsequent in-depth studies are absolutely needed specifically looking at the differences between wedge resections and segmentectomies in the context of early lung cancer.”

Fontaine also stressed the need to take into account the aggressiveness of the tumor.

“Size is only one of multiple factors that determine how aggressive a tumor is,” Fontaine said. “The thoracic surgeon must evaluate a tumor and tailor the approach to how aggressive it is. Less aggressive tumors do just as well with wedge and segmentectomies, but more aggressive tumors probably won’t do as well with a wedge resection compared to segmentectomy.”

More specific research is underway comparing lobectomy versus segmentectomy. Results are expected to be presented in May at the American Thoracic Society International Conference in Washington, D.C.