Segmentectomy Is Supported as Standard of Care for Small, Peripheral Non–Small-Cell Lung Cancer

Surgical resection via lobectomy is the standard treatment for patients with early-stage lung cancer. However, indications for sublobar resection of early-stage lung cancer have recently expanded to include small-sized, peripheral tumors with no lymph node involvement. Now, Japanese oncology groups have assessed whether segmentectomy is noninferior to lobectomy in treatment of clinical stage IA, small-sized, peripheral non–small-cell lung cancer (NSCLC).

This phase 3, randomized, controlled trial included 1106 patients with the following findings on contrast-enhanced computed tomography: a single tumor not located in the middle lobe, the center of which was in the outer third of the lung field; tumor diameter ≤2 cm; and no evidence of lymph node metastasis. The primary endpoint was overall survival.

Patients who underwent segmentectomy had a significantly higher 5-year overall survival (94.3% vs. 91.1%). The secondary endpoint of 5-year, relapse-free survival was nearly identical between the two groups (88.0% in segmentectomy vs. 87.9% for lobectomy). The probability of local recurrence in the segmentectomy group was approximately doubled compared with the lobectomy group (11% vs. 5%). At a median follow-up of 7.3 years, the greater number of deaths in the lobectomy group (83 vs. 58) was not the result of the primary NSCLC, but rather other cancers (including second primary lung cancer) and non–lung-cancer causes, including respiratory and cerebrovascular diseases.